Dataset Information

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

ABSTRACT:

Importance

SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.

Objective

To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections.

Design, setting, and participants

Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling.

Exposure

SARS-CoV-2 infection.

Main outcomes and measures

PASC and 44 participant-reported symptoms (with severity thresholds).

Results

A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.

Conclusions and relevance

A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.

SUBMITTER: Thaweethai T

PROVIDER: S-EPMC10214179 | biostudies-literature | 2023 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

Thaweethai Tanayott T Jolley Sarah E SE Karlson Elizabeth W EW Levitan Emily B EB Levy Bruce B McComsey Grace A GA McCorkell Lisa L Nadkarni Girish N GN Parthasarathy Sairam S Singh Upinder U Walker Tiffany A TA Selvaggi Caitlin A CA Shinnick Daniel J DJ Schulte Carolin C M CCM Atchley-Challenner Rachel R Alba George A GA Alicic Radica R Altman Natasha N Anglin Khamal K Argueta Urania U Ashktorab Hassan H Baslet Gaston G Bassett Ingrid V IV Bateman Lucinda L Bedi Brahmchetna B Bhattacharyya Shamik S Bind Marie-Abele MA Blomkalns Andra L AL Bonilla Hector H Brim Hassan H Bush Patricia A PA Castro Mario M Chan James J Charney Alexander W AW Chen Peter P Chibnik Lori B LB Chu Helen Y HY Clifton Rebecca G RG Costantine Maged M MM Cribbs Sushma K SK Davila Nieves Sylvia I SI Deeks Steven G SG Duven Alexandria A Emery Ivette F IF Erdmann Nathan N Erlandson Kristine M KM Ernst Kacey C KC Farah-Abraham Rachael R Farner Cheryl E CE Feuerriegel Elen M EM Fleurimont Judes J Fonseca Vivian V Franko Nicholas N Gainer Vivian V Gander Jennifer C JC Gardner Edward M EM Geng Linda N LN Gibson Kelly S KS Go Minjoung M Goldman Jason D JD Grebe Halle H Greenway Frank L FL Habli Mounira M Hafner John J Han Jenny E JE Hanson Keith A KA Heath James J Hernandez Carla C Hess Rachel R Hodder Sally L SL Hoffman Matthew K MK Hoover Susan E SE Huang Beatrice B Hughes Brenna L BL Jagannathan Prasanna P John Janice J Jordan Michael R MR Katz Stuart D SD Kaufman Elizabeth S ES Kelly John D JD Kelly Sara W SW Kemp Megan M MM Kirwan John P JP Klein Jonathan D JD Knox Kenneth S KS Krishnan Jerry A JA Kumar Andre A Laiyemo Adeyinka O AO Lambert Allison A AA Lanca Margaret M Lee-Iannotti Joyce K JK Logarbo Brian P BP Longo Michele T MT Luciano Carlos A CA Lutrick Karen K Maley Jason H JH Mallett Gail G Marathe Jai G JG Marconi Vincent V Marshall Gailen D GD Martin Christopher F CF Matusov Yuri Y Mehari Alem A Mendez-Figueroa Hector H Mermelstein Robin R Metz Torri D TD Morse Richard R Mosier Jarrod J Mouchati Christian C Mullington Janet J Murphy Shawn N SN Neuman Robert B RB Nikolich Janko Z JZ Ofotokun Ighovwerha I Ojemakinde Elizabeth E Palatnik Anna A Palomares Kristy K Parimon Tanyalak T Parry Samuel S Patterson Jan E JE Patterson Thomas F TF Patzer Rachel E RE Peluso Michael J MJ Pemu Priscilla P Pettker Christian M CM Plunkett Beth A BA Pogreba-Brown Kristen K Poppas Athena A Quigley John G JG Reddy Uma U Reece Rebecca R Reeder Harrison H Reeves W B WB Reiman Eric M EM Rischard Franz F Rosand Jonathan J Rouse Dwight J DJ Ruff Adam A Saade George G Sandoval Grecio J GJ Santana Jorge L JL Schlater Shannon M SM Sciurba Frank C FC Shepherd Fitzgerald F Sherif Zaki A ZA Simhan Hyagriv H Singer Nora G NG Skupski Daniel W DW Sowles Amber A Sparks Jeffrey A JA Sukhera Fatima I FI Taylor Barbara S BS Teunis Larissa L Thomas Robert J RJ Thorp John M JM Thuluvath Paul P Ticotsky Amberly A Tita Alan T AT Tuttle Katherine R KR Urdaneta Alfredo E AE Valdivieso Daisy D VanWagoner Timothy M TM Vasey Andrew A Verduzco-Gutierrez Monica M Wallace Zachary S ZS Ward Honorine D HD Warren David E DE Weiner Steven J SJ Welch Shelley S Whiteheart Sidney W SW Wiley Zanthia Z Wisnivesky Juan P JP Yee Lynn M LM Zisis Sokratis S Horwitz Leora I LI Foulkes Andrea S AS

JAMA 20230601 22

<h4>Importance</h4>SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals.<h4>Objective</h4>To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vac ...[more]

PMID: 37278994

Similar Datasets

Project description:BACKGROUNDIndividuals recovering from COVID-19 frequently experience persistent respiratory ailments, which are key elements of postacute sequelae of SARS-CoV-2 infection (PASC); however, little is known about the underlying biological factors that may direct lung recovery and the extent to which these are affected by COVID-19 severity.METHODSWe performed a prospective cohort study of individuals with persistent symptoms after acute COVID-19, collecting clinical data, pulmonary function tests, and plasma samples used for multiplex profiling of inflammatory, metabolic, angiogenic, and fibrotic factors.RESULTSSixty-one participants were enrolled across 2 academic medical centers at a median of 9 weeks (interquartile range, 6-10 weeks) after COVID-19 illness: n = 13 participants (21%) had mild COVID-19 and were not hospitalized, n = 30 participants (49%) were hospitalized but were considered noncritical, and n = 18 participants (30%) were hospitalized and in the intensive care unit (ICU). Fifty-three participants (85%) had lingering symptoms, most commonly dyspnea (69%) and cough (58%). Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and diffusing capacity for carbon monoxide (DLCO) declined as COVID-19 severity increased (P < 0.05) but these values did not correlate with respiratory symptoms. Partial least-squares discriminant analysis of plasma biomarker profiles clustered participants by past COVID-19 severity. Lipocalin-2 (LCN2), MMP-7, and HGF identified by our analysis were significantly higher in the ICU group (P < 0.05), inversely correlated with FVC and DLCO (P < 0.05), and were confirmed in a separate validation cohort (n = 53).CONCLUSIONSubjective respiratory symptoms are common after acute COVID-19 illness but do not correlate with COVID-19 severity or pulmonary function. Host response profiles reflecting neutrophil activation (LCN2), fibrosis signaling (MMP-7), and alveolar repair (HGF) track with lung impairment and may be novel therapeutic or prognostic targets.FundingNational Heart, Lung, and Blood Institute (K08HL130557 and R01HL142818), American Heart Association (Transformational Project Award), the DeLuca Foundation Award, a donation from Jack Levin to the Benign Hematology Program at Yale University, and Duke University.

Project description:BackgroundPostacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) can affect many organ systems. However, temporal changes during the coronavirus disease 2019 (Covid-19) pandemic, including the evolution of SARS-CoV-2, may have affected the risk and burden of PASC. Whether the risk and burden of PASC have changed over the course of the pandemic is unclear.MethodsWe used health records of the Department of Veterans Affairs to build a study population of 441,583 veterans with SARS-CoV-2 infection between March 1, 2020, and January 31, 2022, and 4,748,504 noninfected contemporaneous controls. We estimated the cumulative incidence of PASC at 1 year after SARS-CoV-2 infection during the pre-delta, delta, and omicron eras of the Covid-19 pandemic.ResultsAmong unvaccinated persons infected with SARS-CoV-2, the cumulative incidence of PASC during the first year after infection was 10.42 events per 100 persons (95% confidence interval [CI], 10.22 to 10.64) in the pre-delta era, 9.51 events per 100 persons (95% CI, 9.26 to 9.75) in the delta era, and 7.76 events per 100 persons (95% CI, 7.57 to 7.98) in the omicron era (difference between the omicron and pre-delta eras, -2.66 events per 100 persons [95% CI, -2.93 to -2.36]; difference between the omicron and delta eras, -1.75 events per 100 persons [95% CI, -2.08 to -1.42]). Among vaccinated persons, the cumulative incidence of PASC at 1 year was 5.34 events per 100 persons (95% CI, 5.10 to 5.58) during the delta era and 3.50 events per 100 persons (95% CI, 3.31 to 3.71) during the omicron era (difference between the omicron and delta eras, -1.83 events per 100 persons; 95% CI, -2.14 to -1.52). Vaccinated persons had a lower cumulative incidence of PASC at 1 year than unvaccinated persons (difference during the delta era, -4.18 events per 100 persons [95% CI, -4.47 to -3.88]; difference during the omicron era, -4.26 events per 100 persons [95% CI, -4.49 to -4.05]). Decomposition analyses showed 5.23 (95% CI, 4.97 to 5.47) fewer PASC events per 100 persons at 1 year during the omicron era than during the pre-delta and delta eras combined; 28.11% of the decrease (95% CI, 25.57 to 30.50) was attributable to era-related effects (changes in the virus and other temporal effects), and 71.89% (95% CI, 69.50 to 74.43) was attributable to vaccines.ConclusionsThe cumulative incidence of PASC during the first year after SARS-CoV-2 infection decreased over the course of the pandemic, but the risk of PASC remained substantial even among vaccinated persons who had SARS-CoV-2 infection in the omicron era. (Supported by the Department of Veterans Affairs.).

Project description:ImportanceThe postacute sequelae of SARS-CoV-2 infection (PASC) has emerged as a long-term complication in adults, but current understanding of the clinical presentation of PASC in children is limited.ObjectiveTo identify diagnosed symptoms, diagnosed health conditions, and medications associated with PASC in children.Design, setting and participantsThis retrospective cohort study used electronic health records from 9 US children's hospitals for individuals younger than 21 years who underwent antigen or reverse transcriptase-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 between March 1, 2020, and October 31, 2021, and had at least 1 encounter in the 3 years before testing.ExposuresSARS-CoV-2 positivity by viral test (antigen or RT-PCR).Main outcomes and measuresSyndromic (symptoms), systemic (conditions), and medication PASC features were identified in the 28 to 179 days following the initial test date. Adjusted hazard ratios (aHRs) were obtained for 151 clinically predicted PASC features by contrasting viral test-positive groups with viral test-negative groups using proportional hazards models, adjusting for site, age, sex, testing location, race and ethnicity, and time period of cohort entrance. The incidence proportion for any syndromic, systemic, or medication PASC feature was estimated in the 2 groups to obtain a burden of PASC estimate.ResultsAmong 659 286 children in the study sample, 348 091 (52.8%) were male, and the mean (SD) age was 8.1 (5.7) years. A total of 59 893 (9.1%) tested positive by viral test for SARS-CoV-2, and 599 393 (90.9%) tested negative. Most were tested in outpatient testing facility settings (322 813 [50.3%]) or office settings (162 138 [24.6%]). The most common syndromic, systemic, and medication features were loss of taste or smell (aHR, 1.96; 95% CI, 1.16-3.32), myocarditis (aHR, 3.10; 95% CI, 1.94-4.96), and cough and cold preparations (aHR, 1.52; 95% CI, 1.18-1.96), respectively. The incidence of at least 1 systemic, syndromic, or medication feature of PASC was 41.9% (95% CI, 41.4-42.4) among viral test-positive children vs 38.2% (95% CI, 38.1-38.4) among viral test-negative children, with an incidence proportion difference of 3.7% (95% CI, 3.2-4.2). A higher strength of association for PASC was identified in those cared for in the intensive care unit during the acute illness phase, children younger than 5 years, and individuals with complex chronic conditions.Conclusions and relevanceIn this large-scale, exploratory study, the burden of pediatric PASC that presented to health systems was low. Myocarditis was the most commonly diagnosed PASC-associated condition. Acute illness severity, young age, and comorbid complex chronic disease increased the risk of PASC.

Project description:ImportanceObesity is associated with increased severity of COVID-19. Whether obesity is associated with an increased risk of post-acute sequelae of SARS-CoV-2 infection (PASC) among pediatric populations, independent of its association with acute infection severity, is unclear.ObjectiveTo quantify the association of body mass index (BMI) status before SARS-CoV-2 infection with pediatric PASC risk, controlling for acute infection severity.Design, setting, and participantsThis retrospective cohort study occurred at 26 US children's hospitals from March 2020 to May 2023 with a minimum follow-up of 179 days. Eligible participants included children and young adults aged 5 to 20 years with SARS-CoV-2 infection. Data analysis was conducted from October 2023 to January 2024.ExposuresBMI status assessed within 18 months before infection; the measure closest to the index date was selected. The BMI categories included healthy weight (≥5th to <85th percentile for those aged 5-19 years or ≥18.5 to <25 for those aged >19 years), overweight (≥85th to <95th percentile for those aged 5-19 years or ≥25 to <30 for for those aged >19 years), obesity (≥95th percentile to <120% of the 95th percentile for for those aged 5-19 years or ≥30 to <40 for those aged >19 years), and severe obesity (≥120% of the 95th percentile for those aged 5-19 years or ≥40 for those aged >19 years).Main outcomes and measuresTo identify PASC, a diagnostic code specific for post-COVID-19 conditions was used and a second approach used clusters of symptoms and conditions that constitute the PASC phenotype. Relative risk (RR) for the association of BMI with PASC was quantified by Poisson regression models, adjusting for sociodemographic, acute COVID severity, and other clinical factors.ResultsA total of 172 136 participants (mean [SD] age at BMI assessment 12.6 [4.4] years; mean [SD] age at cohort entry, 13.1 [4.4] years; 90 187 female [52.4%]) were included. Compared with participants with healthy weight, those with obesity had a 25.4% increased risk of PASC (RR, 1.25; 95% CI, 1.06-1.48) and those with severe obesity had a 42.1% increased risk of PASC (RR, 1.42; 95% CI, 1.25-1.61) when identified using the diagnostic code. Compared with those with healthy weight, there was an increased risk for any occurrences of PASC symptoms and conditions among those with obesity (RR, 1.11; 95% CI, 1.06-1.15) and severe obesity (RR, 1.17; 95% CI, 1.14-1.21), and the association held when assessing total incident occurrences among those with overweight (RR, 1.05; 95% CI, 1.00-1.11), obesity (RR, 1.13; 95% CI, 1.09-1.19), and severe obesity (RR, 1.18; 95% CI, 1.14-1.22).Conclusions and relevanceIn this cohort study, elevated BMI was associated with a significantly increased PASC risk in a dose-dependent manner, highlighting the need for targeted care to prevent chronic conditions in at-risk children and young adults.

Dataset Information

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

Importance

Objective

Design, setting, and participants

Exposure

Main outcomes and measures

Results

Conclusions and relevance

Publications

Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets