Relationship Between Acute Severe Acute Respiratory Syndrome Coronavirus 2 Viral Clearance and Long Coronavirus 2019 (Long COVID) Symptoms: A Cohort Study

IF 8.2 1区 医学 Q1 IMMUNOLOGY
Carly Herbert, Annukka A R Antar, John Broach, Colton Wright, Pamela Stamegna, Katherine Luzuriaga, Nathaniel Hafer, David D McManus, Yukari C Manabe, Apurv Soni
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Abstract

Background The relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral dynamics during acute infection and the development of long coronavirus disease 2019 (COVID-19), or “long COVID,” is largely unknown. Methods Between October 2021 and February 2022, 7361 people not known to have COVID-19 self-collected nasal swab samples for SARS-CoV-2 reverse-transcription polymerase chain reaction testing every 24–48 hours for 10–14 days. Participants whose first known SARS-CoV-2 infection was detected were surveyed for long COVID in August 2023. Their slopes of viral clearance were modeled using linear mixed effects models with random slopes and intercepts, and the relative risk (RR) of long COVID based on viral slopes was calculated using a log binomial model, adjusted for age, symptoms, and variant. Sex-based interaction terms were also evaluated for significance. Results A total of 172 participants were eligible for analyses, and 59 (34.3%) reported long COVID. The risk of long COVID with 3–4 symptoms (adjusted RR, 2.44 [95% confidence interval, .88–6.82]) and ≥5 symptoms (4.97 [1.90–13.0]) increased with each unit increase in slope of viral clearance. While the probability of long COVID increased with slowed viral clearance among women, the same relationship was not observed among men (interaction term: P = .02). Acute SARS-CoV-2 symptoms of abdominal pain (adjusted RR, 5.41 [95% confidence interval, 2.44–12.0]), nausea (3.01 [1.31–6.89]), and body aches (2.58 [1.26–5.30]) were most strongly associated with long COVID. Conclusions We observed that slower viral clearance rates during acute COVID-19 were associated with increased risk and more symptoms of long COVID . Early viral-host dynamics appear to be mechanistically linked to the development of long COVID.
背景 严重急性呼吸系统综合征冠状病毒 2(SARS-CoV-2)急性感染期间的病毒动态与 2019 年长冠状病毒病(COVID-19)或 "长 COVID "的发展之间的关系在很大程度上是未知的。方法 在 2021 年 10 月至 2022 年 2 月期间,7361 名未被发现患有 COVID-19 的人自取了鼻拭子样本,在 10-14 天内每 24-48 小时进行一次 SARS-CoV-2 反转录聚合酶链反应检测。2023 年 8 月,对首次发现 SARS-CoV-2 感染者进行了长 COVID 调查。使用随机斜率和截距的线性混合效应模型对他们的病毒清除斜率进行建模,并使用对数二项式模型计算基于病毒斜率的长COVID相对风险(RR),并对年龄、症状和变异进行调整。还评估了基于性别的交互项的显著性。结果 共有 172 名参与者符合分析条件,其中 59 人(34.3%)报告了长 COVID。随着病毒清除率斜率每增加一个单位,出现 3-4 种症状(调整后 RR 值为 2.44 [95% 置信区间为 0.88-6.82])和≥5 种症状(4.97 [1.90-13.0])的长 COVID 风险就会增加。虽然女性出现长 COVID 的概率随着病毒清除率的减慢而增加,但在男性中却没有观察到同样的关系(交互项:P = .02)。急性 SARS-CoV-2 症状中的腹痛(调整后 RR 值为 5.41 [95% 置信区间为 2.44-12.0])、恶心(3.01 [1.31-6.89])和全身酸痛(2.58 [1.26-5.30])与长 COVID 的关系最为密切。结论 我们观察到,急性 COVID-19 期间较慢的病毒清除率与长期 COVID 的风险增加和症状增多有关。早期的病毒-宿主动态似乎与长程COVID的发展存在机理上的联系。
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来源期刊
Clinical Infectious Diseases
Clinical Infectious Diseases 医学-传染病学
CiteScore
25.00
自引率
2.50%
发文量
900
审稿时长
3 months
期刊介绍: Clinical Infectious Diseases (CID) is dedicated to publishing original research, reviews, guidelines, and perspectives with the potential to reshape clinical practice, providing clinicians with valuable insights for patient care. CID comprehensively addresses the clinical presentation, diagnosis, treatment, and prevention of a wide spectrum of infectious diseases. The journal places a high priority on the assessment of current and innovative treatments, microbiology, immunology, and policies, ensuring relevance to patient care in its commitment to advancing the field of infectious diseases.
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