Associations Between Inflammatory and Catecholamine Markers and Clinical Outcomes in People with Post-Acute SARS-CoV-2 Infection.

Purpose: The diagnosis of post-acute SARS-CoV-2 infection (PASC) is broad, referring to new or persistent health problems >four weeks after being infected with SARSCoV-2. The aim of this study was to determine whether cytokines, chemokines or catecholamine levels could specify the clinical condition.

Patients and methods: Seventy-nine participants participated in person to study PASC. They were average 51 years (mean), 52% female, 62% Caucasian, 11% African American and 37% Hispanic with a mean BMI of 30.5. Most prevalent symptoms were fatigue, memory loss and shortness of breath. We extracted co-morbid conditions, length of hospital stay and course and laboratory values; medications, history of regular exercise (total of 150 minutes/week), measures of cognition (PCCOG), including Color Word Interference Test (CWIT), Coding, Arithmetic, Matrix Reasoning), clinical assessment of health behavior change, and several patient reported outcomes (PROs) (Edmonton Symptom Assessment System (ESAS), health-related quality of life instrument (EQ5D), anxiety and depression (GAD7, PHQ9) and fatigue (Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F).

Results: These data suggest that people with PASC are more likely to report lower levels of physical well-being, emotional well-being and higher fatigue levels than the non-PASC population. Epinephrine levels correlate statistically significantly with PROs (p<0.05), for overall FACIT-F, as well as the physical and functional subscales. The fatigue severity self-report, PHQ9 and number of symptoms were also significantly correlated. Interleukin-1 beta (IL1b) was inversely correlated with the Physical Well Being (PWB) and Emotional Well Being (EWB) FACIT-F subscales, the GAD7 and the PCCOG scale (p<0.05).

Conclusion: Participants in this observational study of PASC report lower levels of emotional, physical well-being, more fatigue, anxiety and depression than are reported in population norms. Epinephrine and IL1b correlate with these findings and may offer a biological measurement, providing clinically useful information for tracking persistence or recovery. These findings may encourage further study to develop newer treatment approaches.