Introduction

COVID-19 long-haulers, also decribed as having “long-COVID” or post-acute COVID-19 syndrome, represent 10% of COVID-19 patients and remain understudied.

Methods

In this prospective study, we recruited 30 consecutive patients seeking medical help for persistent symptoms (> 30 days) attributed to COVID-19. All reported a viral illness compatible with COVID-19. The patients underwent a multi-modal evaluation, including clinical, psychologic, virologic and specific immunologic assays and were followed longitudinally. A group of 17 convalescent COVID-19 individuals without persistent symptoms were included as a comparison group.

Results

The median age was 40 [interquartile range: 35–54] years and 18 (60%) were female. At a median time of 152 [102–164] days after symptom onset, fever, cough and dyspnea were less frequently reported compared with the initial presentation, but paresthesia and burning pain emerged in 18 (60%) and 13 (43%) patients, respectively. The clinical examination was unremarkable in all patients, although the median fatigue and pain visual analog scales were 7 [5–8] and 5 [2–6], respectively. Extensive biologic studies were unremarkable, and multiplex cytokines and ultra-sensitive interferon-α2 measurements were similar between long-haulers and convalescent COVID-19 individuals without persistent symptoms. Using SARS-CoV-2 serology and IFN-γ ELISPOT, we found evidence of a previous SARS-CoV-2 infection in 50% (15/30) of patients, with evidence of a lack of immune response, or a waning immune response, in two patients. Finally, psychiatric evaluation showed that 11 (36.7%), 13 (43.3%) and 9 (30%) patients had a positive screening for anxiety, depression and post-traumatic stress disorder, respectively.

Conclusions

Half of patients seeking medical help for post-acute COVID-19 syndrome lack SARS-CoV-2 immunity. The presence of SARS-CoV-2 immunity, or not, had no consequence on the clinical or biologic characteristics of post-acute COVID-19 syndrome patients, all of whom reported severe fatigue, altered quality of life and psychologic distress.

中文翻译：

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通过对因 SARS-CoV-2 感染而出现长期症状的患者进行前瞻性多模态评估来提炼“长期 COVID”

介绍

COVID-19 长途运输者，也被称为“长期 COVID”或急性 COVID-19 后综合征，占 COVID-19 患者的 10%，并且仍未得到充分研究。

方法

在这项前瞻性研究中，我们连续招募了 30 名因 COVID-19 引起的持续症状（> 30 天）寻求医疗帮助的患者。所有人都报告了与 COVID-19 兼容的病毒性疾病。患者接受了多模式评估，包括临床、心理、病毒学和特异性免疫学检测，并进行了纵向随访。一组 17 名没有持续症状的康复期 COVID-19 个体被纳入作为对照组。

结果

中位年龄为 40 [四分位距：35-54] 岁，18 岁 (60%) 为女性。在症状出现后 152 [102-164] 天的中位时间，与最初就诊相比，发烧、咳嗽和呼吸困难的报告频率较低，但 18 (60%) 和 13 (43%) 名患者出现感觉异常和灼痛， 分别。尽管疲劳和疼痛视觉模拟量表的中位数分别为 7 [5-8] 和 5 [2-6]，但所有患者的临床检查均无异常。广泛的生物学研究并不显着，长途运输者和没有持续症状的康复期 COVID-19 个体的多重细胞因子和超敏感干扰素-α2 测量结果相似。使用 SARS-CoV-2 血清学和 IFN-γ ELISPOT，我们发现 50% (15/30) 的患者之前感染过 SARS-CoV-2 的证据，有两名患者缺乏免疫反应或免疫反应减弱的证据。最后，精神病学评估显示，分别有 11 (36.7%)、13 (43.3%) 和 9 (30%) 名患者的焦虑、抑郁和创伤后应激障碍筛查呈阳性。

结论

一半因急性 COVID-19 后综合征寻求医疗帮助的患者缺乏 SARS-CoV-2 免疫力。SARS-CoV-2 免疫力的存在与否对急性 COVID-19 后综合征患者的临床或生物学特征没有影响，所有这些患者都报告了严重疲劳、生活质量改变和心理困扰。