Protracted inflammation linked to post-COVID lung problems
New findings suggest monitoring COVID-19 patients for signs of
inflammation could help identify those at risk of long-term lung problems

Date:
February 8, 2022
Source:
eLife
Summary:
Scientists have revealed that protracted inflammation following
COVID-19 is strongly linked to long-term changes in lung structure
and function.



FULL STORY ========================================================================== Scientists have revealed that protracted inflammation following COVID-19
is strongly linked to long-term changes in lung structure and function, according to a report published today in eLife.


==========================================================================
The results suggest that monitoring people for markers of inflammation
after infection with the SARS-CoV-2 virus could help identify those at
risk of long- term lung problems and optimise follow-up care.

Although a vast majority of COVID-19 patients display mild disease, a significant proportion reports lingering or recurring clinical symptoms
and full recovery can take several months to years.

"Symptoms lasting beyond 12 weeks are found in as many as 10% of COVID-19 patients and robust, resource-saving tools assessing people's individual
risk of lung complications are urgently needed," says Thomas Sonnweber,
a lung specialist at the Medical University of Innsbruck, Austria, and
co-first author of the study alongside Piotr Tymoszuk. "We analysed the frequency of lung structure and function changes and persistent symptoms
in patients six months after a COVID-19 diagnosis, to investigate whether
there are clinical hallmarks that can predict their risk of developing
long COVID." The researchers evaluated the recovery of 145 primarily hospitalised patients diagnosed with COVID-19 between March and June
2020 who took part in the Austrian clinical study called 'Development
of Interstitial Lung Disease in COVID-19' (CovILD).

They retrospectively assessed patient characteristics during their acute
COVID- 19 infection and then performed follow-up investigations at 60,
100 and 180 days. At each visit, they assessed symptoms and physical performance using a questionnaire, and conducted lung function tests,
blood tests and a chest scan.

Almost half (49%) of patients had persistent complaints six months
after diagnosis, with the most common complaints being impaired
physical performance (34.7% of patients), sleep disorders (27.1%)
and breathlessness on exertion (22.8%). Although the frequency of these symptoms declined as time passed, they were slower to resolve towards the
end of the convalescence period, at the 100- day and 180-day follow-up
visits.

Six months after diagnosis, a third of patients (33.6%) had impaired
lung function and almost half of patients (48.5%) had chest scans showing structural lung abnormalities, with one in five patients (19.4%) having moderate-to-severe lung alterations.

To identify risk factors associated with these long-term problems, the
team used machine learning algorithms to look for patterns of clinical
features in the patients who had long COVID symptoms. They found that
risk factors linked to severe and critical COVID-19 infection -- namely
being male, having long- term conditions such as high blood pressure,
and high anti-SARS-CoV-2 antibody levels -- were also linked to long-term symptom persistence. But in addition to these factors, elevated markers
of inflammation -- both body-wide and within blood vessels -- were also associated with long-term lung abnormalities.

The team then tested if algorithms using these risk factors could predict
COVID outcomes in a different group of patients. They found that although
the inflammation markers predicted who would develop lung structure abnormalities, they could not accurately predict who would develop
lung function problems or other symptoms such as breathlessness. This
suggests that even if patients have detectable changes to their lungs
60 days after diagnosis, this may not manifest as symptoms or changes
in lung function yet, but could still lead to problems later.

The algorithms need to be validated in larger groups of patients with
COVID-19 before they can be reliably used to predict long-term COVID-19 outcomes. To this end, the authors have published their findings as an open-source risk assessment tool for other researchers to use.

"In our study group of patients, we found a high frequency of structural
and functional lung abnormalities and persistent symptoms six months
after a COVID- 19 diagnosis, and a recovery trajectory that slowed
after three months," concludes Judith Lo"ffler-Ragg, a lung specialist
at the Medical University of Innsbruck, and co-senior author of the
study alongside Ivan Tancevski. "Our risk models revealed a set of
clinical measurements linked to lengthened recovery, independent to
the severity of infection, which include known inflammatory markers. We
hope that these could be used to identify those at risk of persistent
lung problems and optimise their care to prevent long-term disability." ========================================================================== Story Source: Materials provided by eLife. Note: Content may be edited
for style and length.


========================================================================== Journal Reference:
1. Thomas Sonnweber, Piotr Tymoszuk, Sabina Sahanic, Anna Boehm, Alex
Pizzini, Anna Luger, Christoph Schwabl, Manfred Nairz, Philipp
Grubwieser, Katharina Kurz, Sabine Koppelsta"tter, Magdalena
Aichner, Bernhard Puchner, Alexander Egger, Gregor Hoermann,
Ewald Wo"ll, Gu"nter Weiss, Gerlig Widmann, Ivan Tancevski,
Judith Lo"ffler-Ragg.

Investigating phenotypes of pulmonary COVID-19 recovery - a
longitudinal observational prospective multicenter trial. eLife,
2022; 11 DOI: 10.7554/eLife.72500 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/02/220208104942.htm
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