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Clinical Update of Long COVID
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Clinical Update of Long COVID

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Rehabilitation".

Deadline for manuscript submissions: closed (18 April 2024) | Viewed by 10669

Special Issue Editor

Dr. Vitaliano Nicola Quaranta

E-Mail Website
Guest Editor
Department of Basic Medical Sciences, Neuroscience and Sense Organs, Section of Respiratory Disease, University “Aldo Moro” of Bari, 70121 Bari, Italy
Interests: asthma; chronic obstructive pulmonary disease; pneumonia; bronchitis; respiratory insufficiency; snoring; tuberculosis; pulmonary mycobacteriosis; chronic respiratory insufficiency
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Long COVID, also known as post-acute sequelae of SARS-CoV-2 infection (PASC) or chronic COVID-19 syndrome, refers to a condition where individuals experience lingering symptoms and health issues well beyond the typical recovery period from acute COVID-19. While most people infected with COVID-19 experience mild to moderate symptoms and recover within a few weeks, a significant portion of patients, even including those who initially had mild cases, continue to experience persistent symptoms for months. The symptoms of long COVID can vary widely and may include fatigue, shortness of breath, brain fog, joint pain, chest pain, headaches, heart palpitations, loss of taste or smell, and difficulty concentrating. These symptoms can significantly impact the quality of life and daily functioning of those affected. The exact cause of long COVID is not yet fully understood, and research is ongoing to allow us to comprehend the underlying mechanisms better. The management of long COVID often involves a multidisciplinary approach, with healthcare providers addressing specific symptoms and offering supportive care based on individual needs. As this is a relatively new condition, the medical community is continuously studying and learning more about long COVID to provide better care and support for those affected.

Dr. Vitaliano Nicola Quaranta
Guest Editor

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Keywords

  • long COVID
  • SARS-CoV-2
  • persistent symptoms
  • management
  • rehabilitation

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Published Papers (6 papers)

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Research

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11 pages, 1265 KiB  
Article
Organ-Dysfunction Markers in Mild-to-Moderate COVID-19 Convalescents
by Aleksandra Wiśniewska, Aleksandra Kijak, Karolina Nowak, Michalina Lulek, Agata Skwarek, Milena Małecka-Giełdowska, Marcin Śmiarowski, Szczepan Wąsik and Olga Ciepiela
J. Clin. Med. 2024, 13(8), 2241; https://doi.org/10.3390/jcm13082241 - 12 Apr 2024
Viewed by 2397
Abstract
Background: A coronavirus disease 2019 (COVID-19) outbreak led to a worldwide pandemic. COVID-19 not only caused acute symptoms during the severe phase of the disease, but also induced long-term side effects on the functioning of many organs and systems. Symptoms that were [...] Read more.
Background: A coronavirus disease 2019 (COVID-19) outbreak led to a worldwide pandemic. COVID-19 not only caused acute symptoms during the severe phase of the disease, but also induced long-term side effects on the functioning of many organs and systems. Symptoms that were associated with the disease and present at least 3 months after recovery were named long COVID. The aim of this study was to assess if mild-to-moderate COVID-19 may lead to the dysfunction of respiratory, cardiovascular, neural, and renal systems in healthy blood donors who recovered from the disease at least 6 months earlier. Methods: Here, we examined 294 adults among volunteer blood donors divided into convalescents (n = 215) and healthy controls (n = 79). Concentrations of soluble CD163, TGF beta, Lp-PLA2, NCAM-1, S100, NGAL, and creatinine were measured either by ELISA or automated methods. The probability value p < 0.05 was considered as statistically significant. Results: We found significant differences in Lp-PLA2, S100, and NCAM-1 between convalescents and never-infected subjects. Lp-PLA2 and NCAM-1 were lower, and S100 higher, in convalescents than in the control group. Conclusion: Mild-to-moderate COVID-19 convalescents are at a low risk of developing lung fibrosis or chronic kidney disease. However, they should regularly carry out their prophylaxis examinations for early detection of possible negative outcomes of COVID-19. Full article
(This article belongs to the Special Issue Clinical Update of Long COVID)
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16 pages, 1259 KiB  
Article
A Comparative Analysis of Liver Injury Markers in Post-COVID Syndrome among Elderly Patients: A Prospective Study
by Adrian Vasile Bota, Felix Bratosin, Satya Sai Sri Bandi, Iulia Bogdan, David Vladut Razvan, Ana-Olivia Toma, Mirela Florica Indries, Andrei Nicolae Csep, Coralia Cotoraci, Mihaela Prodan, Felicia Marc, Flavia Ignuta and Iosif Marincu
J. Clin. Med. 2024, 13(4), 1149; https://doi.org/10.3390/jcm13041149 - 18 Feb 2024
Cited by 2 | Viewed by 1405
Abstract
Background: In the wake of the global COVID-19 pandemic, understanding its prolonged impact on vulnerable populations has become a critical area of investigation. This study aimed to elucidate the distinctive post-acute sequelae of SARS-CoV-2 infection (PASC) and liver injury in Romania’s elderly population, [...] Read more.
Background: In the wake of the global COVID-19 pandemic, understanding its prolonged impact on vulnerable populations has become a critical area of investigation. This study aimed to elucidate the distinctive post-acute sequelae of SARS-CoV-2 infection (PASC) and liver injury in Romania’s elderly population, hypothesizing unique demographic, clinical, and healthcare factors influencing the manifestation. Methods: A longitudinal design was employed, enrolling COVID-19 patients from the Victor Babes Hospital for Infectious Diseases and Pulmonology in Timisoara, Romania. Participants were stratified into three groups based on age and Long COVID status. The study focused on a variety of demographic, clinical, and biological parameters, including liver function tests, to assess the trajectory and severity of liver injury over six months post discharge. Results: Involving 238 participants, the study revealed a significant increase in the duration of hospitalization for those over 65 (15.8 ± 8.2 days) compared to younger groups (p < 0.001). Notably, elderly Long COVID patients exhibited a marked elevation in liver enzymes post discharge, with median ΔALT and ΔAST of 24.1 U/L and 30.2 U/L, respectively, suggesting ongoing liver injury (p < 0.001). Significant metabolic disruptions were observed, with the ΔFasting glucose showing a substantial median decrease of 21.1 mmol/L in the elderly group (p < 0.001). A pronounced reduction in ΔGGT (16.7 U/L) and ΔLDH (48.7 U/L) was noted, indicating a recovery in liver function and reduced tissue damage (p < 0.001). Coagulation profiles and liver fibrosis risk scores, particularly ΔFIB-4 and ΔAPRI, also significantly improved post discharge, indicating a reduced risk of ongoing liver complications. Conclusion: This study confirms the hypothesis of more severe PASC and liver injury among the elderly Romanian population. Significant improvements post discharge suggest a degree of recovery, yet the persistent alterations in liver enzymes, glucose metabolism, and fibrosis risk scores call for continued monitoring and tailored management strategies. Full article
(This article belongs to the Special Issue Clinical Update of Long COVID)
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15 pages, 252 KiB  
Article
Sleep Disturbances as a Consequence of Long COVID-19: Insights from Actigraphy and Clinimetric Examinations—An Uncontrolled Prospective Observational Pilot Study
by Wojciech Tański, Anna Tomasiewicz and Beata Jankowska-Polańska
J. Clin. Med. 2024, 13(3), 839; https://doi.org/10.3390/jcm13030839 - 1 Feb 2024
Cited by 3 | Viewed by 1302
Abstract
The COVID-19 pandemic represents a global health and social challenge. However, the impact of a SARS-CoV-2 infection itself on mental health and sleep quality remains poorly understood. The purpose of the present uncontrolled prospective observational pilot study was to evaluate the impact of [...] Read more.
The COVID-19 pandemic represents a global health and social challenge. However, the impact of a SARS-CoV-2 infection itself on mental health and sleep quality remains poorly understood. The purpose of the present uncontrolled prospective observational pilot study was to evaluate the impact of past COVID-19 disease on the incidence of quantitative and qualitative sleep disturbances. A group of 61 subjects (37 female, 24 male) reported sleep disturbances that had lasted for at least one month and had started after recovery from COVID-19. The study used self-reported instruments: the Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI), as well as an objective method—actigraphy—for quantitative analysis of sleep architecture. It was shown that sleep disturbances most commonly started after recovery (68.3%, n = 41) and lasted for more than one month (83.6%, n = 51). ESS scores of 7.8 ± 5.0 points indicate moderate daytime sleepiness, and ISI scores of 16.3 ± 5.8 points denote moderate insomnia. ESS scores were negatively correlated with total time in bed (r = −0.3780, p = 0.003), total sleep time (r = −0.2969, p = 0.020), and wakefulness after sleep onset (r = −0.2654, p = 0.039). In addition, ESS scores were correlated negatively with the respondents’ age (B = −0.17, p = 0.000) and time from COVID-19 onset. A positive correlation was found between wakefulness after sleep onset and ESS scores (B = −0.05, p = 0.039). ISI scores were positively correlated with time in bed (r = 0.3275, p = 0.010). Female gender was found to be a significant predictor of insomnia’s severity (B = 2.159, t = 3.04, p = 0.004). In conclusion, patients with a history of COVID-19 report long-lasting sleep disturbances that do not subside spontaneously. In the patient group studied, moderate levels of daytime sleepiness and insomnia were found. The most frequently reported problems included irregular sleep, frequent awakenings, and difficulty maintaining sleep, while normal sleep duration was preserved. These findings underscore the need for continued attention to the long-term consequences of COVID-19 on sleep health and emphasize the importance of targeted interventions to address these enduring sleep disturbances in affected individuals. Full article
(This article belongs to the Special Issue Clinical Update of Long COVID)
14 pages, 1163 KiB  
Article
The Predictors of Long COVID in Southeastern Italy
by Vitaliano Nicola Quaranta, Andrea Portacci, Silvano Dragonieri, Cristian Locorotondo, Enrico Buonamico, Fabrizio Diaferia, Ilaria Iorillo, Sara Quaranta and Giovanna Elisiana Carpagnano
J. Clin. Med. 2023, 12(19), 6303; https://doi.org/10.3390/jcm12196303 - 29 Sep 2023
Cited by 7 | Viewed by 1545
Abstract
Introduction: Long COVID is now recognized as a common consequence of the SARS-CoV-2 infection, but we are still far from fully understanding its pathogenesis and predictive factors. Many pathophysiological factors have been studied, including ethnicity. To our knowledge, the risk factors for Long [...] Read more.
Introduction: Long COVID is now recognized as a common consequence of the SARS-CoV-2 infection, but we are still far from fully understanding its pathogenesis and predictive factors. Many pathophysiological factors have been studied, including ethnicity. To our knowledge, the risk factors for Long COVID have not been studied in Southeastern Italy. Aims: The aim of this study was to evaluate the predictive factors of Long COVID in a cohort of patients from Southeastern Italy. Methods: We conducted a retrospective longitudinal study, enrolling inpatients and outpatients diagnosed with COVID-19 from June 2021 to March 2022. A total of 436 subjects were evaluated in an outpatient setting 12 weeks after a SARS-CoV-2 infection, recording comorbidities, symptoms, therapy, and clinical information. Univariate and multivariate binomial logistic regression analyses were performed on different risk factors to define the probability of developing Long COVID. Results: A total of 71.8% of patients (313) developed Long COVID, while the remaining 123 (28.3%) had a complete remission of symptoms 3 months after acute infection. During the acute phase of COVID-19, 68.3% of patients experienced respiratory failure and 81.4% received corticosteroid therapy. In a multivariate analysis, the female sex (SEX M ODD 0.513) and corticosteroids (ODD 2.25) were maintained as predictive values. Conclusions: From our data and in line with other studies, the female sex emerges as a risk factor for Long COVID in the population of Southeastern Italy. Corticosteroid therapy administered in the acute phase also appears to be associated with an increased risk of Long COVID. Although indications for the prescription of corticosteroid therapy in the acute phase were indicated by the presence of pneumonia complicated by respiratory insufficiency, there was an over-prescription of corticosteroid therapy in the real life of our cohort, with 64% of patients having respiratory insufficiency and 81% having corticosteroid therapy. We hypothesize that a synergistic link between viral infection and the side effects of corticosteroid therapy may arise in selected cases. Full article
(This article belongs to the Special Issue Clinical Update of Long COVID)
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Review

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21 pages, 1048 KiB  
Review
Long COVID Syndrome: A Narrative Review on Burden of Age and Vaccination
by Panaiotis Finamore, Elena Arena, Domenica Lupoi, Luisa Savito, Francesca Di Nunzio, Michela Furbatto, Silvano Dragonieri, Raffaele Antonelli Incalzi and Simone Scarlata
J. Clin. Med. 2024, 13(16), 4756; https://doi.org/10.3390/jcm13164756 - 13 Aug 2024
Viewed by 1105
Abstract
Background/Objective: The COVID-19 pandemic has led to the emergence of post-acute COVID-19 syndrome, also known as long COVID, which presents a significant challenge due to its varied symptoms and unpredictable course, particularly in older adults. Similar to COVID-19 infections, factors such as age, [...] Read more.
Background/Objective: The COVID-19 pandemic has led to the emergence of post-acute COVID-19 syndrome, also known as long COVID, which presents a significant challenge due to its varied symptoms and unpredictable course, particularly in older adults. Similar to COVID-19 infections, factors such as age, pre-existing health conditions, and vaccination status may influence the occurrence and severity of long COVID. The objective is to analyze the role of aging in the context of long COVID and to investigate prevalence rates and vaccination efficacy to improve prevention strategies and treatment in this age group. Methods: Four researchers independently conducted a literature search of the PubMed database to trace studies published between July 2020 and July 2024. Results: Aging influences both the likelihood of developing long COVID and the recovery process, due to age-related physiological changes, immune system alterations, and the presence of comorbidities. Vaccination plays a key role in reducing the risk of long COVID by attenuating the inflammatory responses associated with its symptoms. Conclusions: Despite the protection vaccines offer against severe infection, hospitalization, and post-infection sequelae, vaccine hesitancy remains a major obstacle, worsening the impact of long COVID. Promising treatments for this condition include antivirals although further research is needed. Full article
(This article belongs to the Special Issue Clinical Update of Long COVID)
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14 pages, 599 KiB  
Review
The Role of Heparin in Postural Orthostatic Tachycardia Syndrome and Other Post-Acute Sequelae of COVID-19
by Elisabeth Gómez-Moyano, Javier Pavón-Morón, Jorge Rodríguez-Capitán, Daniel Bardán-Rebollar, Teresa Ramos-Carrera, Aurora Villalobos-Sánchez, Iván Pérez de Pedro, Francisco J. Ruiz-García, Javier Mora-Robles, Almudena López-Sampalo, Miguel A. Pérez-Velasco, Maria-Rosa Bernal-López, Ricardo Gómez-Huelgas, Manuel Jiménez-Navarro, Miguel Romero-Cuevas, Francesco Costa, Alicia Trenas and Luis M. Pérez-Belmonte
J. Clin. Med. 2024, 13(8), 2405; https://doi.org/10.3390/jcm13082405 - 20 Apr 2024
Viewed by 2377
Abstract
The therapeutic management and short-term consequences of the coronavirus disease 2019 (COVID-19) are well known. However, COVID-19 post-acute sequelae are less known and represent a public health problem worldwide. Patients with COVID-19 who present post-acute sequelae may display immune dysregulation, a procoagulant state, [...] Read more.
The therapeutic management and short-term consequences of the coronavirus disease 2019 (COVID-19) are well known. However, COVID-19 post-acute sequelae are less known and represent a public health problem worldwide. Patients with COVID-19 who present post-acute sequelae may display immune dysregulation, a procoagulant state, and persistent microvascular endotheliopathy that could trigger microvascular thrombosis. These elements have also been implicated in the physiopathology of postural orthostatic tachycardia syndrome, a frequent sequela in post-COVID-19 patients. These mechanisms, directly associated with post-acute sequelae, might determine the thrombotic consequences of COVID-19 and the need for early anticoagulation therapy. In this context, heparin has several potential benefits, including immunomodulatory, anticoagulant, antiviral, pro-endothelial, and vascular effects, that could be helpful in the treatment of COVID-19 post-acute sequelae. In this article, we review the evidence surrounding the post-acute sequelae of COVID-19 and the potential benefits of the use of heparin, with a special focus on the treatment of postural orthostatic tachycardia syndrome. Full article
(This article belongs to the Special Issue Clinical Update of Long COVID)
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