Long COVID Syndrome: A Case-Control Study - 13/06/23

Doi : 10.1016/j.amjmed.2023.04.022

Rachel-Anne Xuereb, MD, MRCP(UK) ^a,^b, Marica Borg, Dip, MLS ^a, Kevin Vella, Dip, MLS, BSc (Hons) MLS, MSc Pathology ^a, Alex Gatt, MD, FRCP(Edin), FRCPath(UK), FMCPath, MD(Sheff) ^a,^b, Robert G. Xuereb, MD, FRCP, FESC ^a,^b, Christopher Barbara, MD, MSc (Lond), DLSHTM ^a,^b, Stephen Fava, MD, MRCP(UK), FACP, FEFIM, FRCP(Lond), MPhil(Melit), PhD(Exeter) ^a,^b,^⁎ , Caroline J. Magri, MD, MRCP(UK), FEFIM, FESC, MPhil(Melit), M. Int. Cardiol.(UniSR), MSc(Brighton), PhD(Melit) ^a,^b
^a Mater Dei Hospital, Msida, Malta
^b University of Malta Medical School, Msida

^⁎Requests for reprints should be addressed to Professor Stephen Fava, University of Malta Medical School, Tal-Qroqq, Msida MSD 2090, Malta.University of Malta Medical SchoolTal-QroqqMsidaMSD2090Malta

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Abstract

Background

Acute coronavirus disease 2019 (COVID-19) causes various cardiovascular complications. However, it is unknown if there are cardiovascular sequelae in the medium and long-term. The aim of this study was dual. Firstly, we wanted to investigate symptomatology and health-related quality of life (HRQoL) at medium-term follow-up (6 months post-COVID). Secondly, we wanted to assess whether history of COVID-19 and persistent shortness of breath at medium-term follow-up are associated with ongoing inflammation, endothelial dysfunction, and cardiac injury.

Methods

A case-control study was performed. Virologically proven COVID-19 cases and age- and gender-matched controls were interviewed to assess symptoms and HRQoL. Biochemical tests were also performed.

Results

The study comprised 174 cases and 75 controls. The mean age of the participants was 46.1±13.8 years. The median follow-up was 173.5 days (interquartile range 129-193.25 days). There was no significant difference in the demographics between cases and controls. At follow-up, cases had a higher frequency of shortness of breath, fatigue, arthralgia, abnormal taste of food (P <.001), and anosmia. Cases also exhibited worse scores in the general health and role physical domains of the Short Form Survey-36. High-sensitivity C-reactive protein (hsCRP) was significantly higher in the cases, and there was a positive correlation of hsCRP with time. Significant determinants of shortness of breath were age, female gender and white cell count, troponin I, and lower hemoglobin levels at follow-up.

Conclusion

Post-COVID-19 patients have persistent symptomatology at medium-term follow-up. Higher hsCRP in cases and the positive association of hsCRP with time suggest ongoing systemic inflammation in patients persisting for months after COVID-19.

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Keywords : Health-related quality of life, High-sensitivity C-reactive protein, Long COVID, Troponin

Plan

	Funding: This project was funded by Malta Enterprise.
	Conflict of Interest: None.
	Authorship: All authors had access to the data and a role in writing this manuscript.