Factors Associated with Post-Acute Sequelae of SARS-CoV-2 (PASC) After Diagnosis of Symptomatic COVID-19... 2022, Yoo et al

Forbin

Forbin

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ABSTRACT
Background
The incidence of persistent clinical symptoms and risk factors in Post-Acute Sequelae of SARS-CoV-2 (PASC) in diverse US cohorts is unclear. While there are a disproportionate share of COVID-19 deaths in older patients, ethnic minorities, and socially disadvantaged populations in the USA, little information is available on the association of these factors and PASC.

Objective
To evaluate the association of demographic and clinical characteristics with development of PASC.

Design
Prospective observational cohort of hospitalized and high-risk outpatients, April 2020 to February 2021.

Participants
One thousand thirty-eight adults with laboratory-confirmed symptomatic COVID-19 infection.

Main Measures
Development of PASC determined by patient report of persistent symptoms on questionnaires conducted 60 or 90 days after COVID-19 infection or hospital discharge. Demographic and clinical factors associated with PASC.

Key Results
Of 1,038 patients with longitudinal follow-up, 309 patients (29.8%) developed PASC. The most common persistent symptom was fatigue (31.4%) followed by shortness of breath (15.4%) in hospitalized patients and anosmia (15.9%) in outpatients. Hospitalization for COVID-19 (odds ratio [OR] 1.49, 95% [CI] 1.04–2.14), having diabetes (OR, 1.39; 95% CI 1.02–1.88), and higher BMI (OR, 1.02; 95% CI 1–1.04) were independently associated with PASC. Medicaid compared to commercial insurance (OR, 0.49; 95% CI 0.31–0.77) and having had an organ transplant (OR 0.44, 95% CI, 0.26–0.76) were inversely associated with PASC. Age, race/ethnicity, Social Vulnerability Index, and baseline functional status were not associated with developing PASC.

Conclusions
Three in ten survivors with COVID-19 developed a subset of symptoms associated with PASC in our cohort. While ethnic minorities, older age, and social disadvantage are associated with worse acute COVID-19 infection and greater risk of death, our study found no association between these factors and PASC.
 
From the abstract only
The sample is hospitalised and high risk patients.

PASC as defined here is not Long Covid or ME/CFS, simply one or more persistent symptoms 2 to 3 months after acute infection/hospital discharge.

There's no mention of gender being associated with PASC. It's surprising that poverty and older age didn't increase the chance of having persistent symptoms, and having had an organ transplant reduced the chances (the sample size for that was probably pretty small).
 
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Of the 1,296 enrolled in the program between April 2020 to February 2021, 1,038 patients (80.1%) completed follow-up surveys at 30, 60, or 90 days after hospital discharge or outpatient diagnosis and were included in the study.
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The mean age of the cohort was 60 years (interquartile range, 37 to 83) with an even split by gender overall, but more women receiving outpatient care. Thirty percent were White and 42% Latinx. More than one-third of the cohort had diabetes, over 10% had received a solid organ transplant, and mean BMI was nearly 30. Forty-two percent of patients had commercial insurance and mean SVI was 0.46 (interquartile range 0.16 to 0.76). At baseline, most patients could complete vigorous or moderate activities. Men, patients with diabetes, and Latinx patients were more likely to have been admitted to the hospital or the ICU
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The drop out rate was not unreasonably high, but there was probably a skew as to which type of patients dropped out. I can imagine those who had had an organ transplant would be less likely to drop out, whereas patients who did not have ongoing symptoms would be more likely to drop out. The combination of those may well account for the finding that having had a transplant is associated with a lower incidence of PASC.

It's notable that, even in this sample that skewed to older and fatter, "at baseline, most patients could complete vigorous or moderate activities".


In the outpatient setting, PASC patients were younger, more likely to be White, women, and commercially insured. In the inpatient setting, age and race were unrelated to PASC, and women were more likely to report symptoms consistent with PASC.
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The gender skew is there, but it didn't quite make it to signficance. The odds ratio for females was 1.33 against the reference (men, OR=1.0), but the confidence interval for women was 0.99 to 1.79, so not quite significant.

Diabetes was a significant factor.

Patients were characterized as having PASC if they noted persistent COVID-19 symptoms on the 90-day post-discharge survey (or the 60-day survey if the 90-day survey was incomplete).
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The biggest problem with this study for me was the definition of PASC. It's not clear, but possibly just having one persistent symptom at 3 months could qualify someone has having PASC. But we know, especially for hospitalised patients who may have received various drugs, that there are lots of reasons for ongoing symptoms. There didn't seem to be any effort to look at the combinations of symptoms reported and group the respondents according to collections of symptoms. Someone with a lingering symptom of shortness of breath alone, or even shortness of breath and chest pain probably doesn't have much in common in terms of pathology as someone with the full suite of ME/CFS-type symptoms.

I'd really like to see some studies look at whether perturbations of the senses of smell and taste are associated with ME/CFS type symptoms. That might give us a clue as to whether ME/CFS is related to a vulnerability to nerve damage.
 
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