PO10 | Clinical and laboratory features of long-Covid syndrome: a cross-sectional study of 1,337 Covid-19 survivors
C. Ambaglio1, S. V. Benatti2, C. J. Tartari1,3, L. Russo1,3, S. Bolognini1,3, C. Ticozzi1, F. Schieppati1, V. Brusegan1, S. Venturelli2, L. Barcella1, M. Rizzi2, M. Marchetti1,3, A. Falanga1,3 | 1Department of Immunohematology and Transfusion Medicine, Papa Giovanni XXIII Hospital, Bergamo; 2Division of Infectious Diseases, Papa Giovanni XXIII Hospital, Bergamo; 3Department of Medicine and Surgery, University of Milan Bicocca, Monza, Italy
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Background: The term ‘long-Covid’ is used to describe in Covid-19 survivors the persistence of symptoms beyond 4 weeks and includes ‘ongoing symptomatic’ (4-12 weeks) and ‘post-Covid-19’ syndrome (>12 weeks) phases, based on symptoms’ duration. Aim: To evaluate the contribution of circulating hemostatic biomarker alterations to the diagnosis of long-Covid syndrome.
Methods: A clinical and diagnostic multidisciplinary follow-up of Covid-19 patients discharged from our Institution after the first pandemic wave was implemented (ACCORDI Study, July – November 2020). In 1310 out of 1337 Covid-19 survivors who attended the clinical visit, blood samples were obtained for measurements of blood cell count, liver and renal function tests, LDH, C-reactive protein, fibrinogen, prothrombin fragment 1+2, D-dimer, von Willebrand factor antigen, thrombomodulin (TM), tissue plasminogen activator and its inhibitor PAI-1.
Results: In the 1337 survivor cohort (863M/474F, median age 60 years, median time from Covid-19 onset=127 days), clinical symptoms were: cardiopulmonary in 50% of subjects, flu-like in 35%, respiratory in 27%, and neurological in 11%. The long-Covid syndrome was diagnosed in 655 patients (375M/280F): 101 classified as ‘ongoing symptomatic’ and 554 as ‘post-Covid’. Among study population, 56 survivors experienced VTE during the acute phase (43M/13F, median age 62 years). 80% had isolated pulmonary embolism; 16% isolated proximal deep vein thrombosis; 4% deep vein thrombosis and pulmonary embolism. A significant association appeared between VTE during acute phase and development of long-Covid syndrome. The hemostatic laboratory analysis of 1310 samples showed no significant differences in the biomarkers’ levels between long-COVID and symptom-free survivors. However, among subjects assessed within 12 weeks from disease onset, the ‘ongoing symptomatic’ group showed significantly higher TM levels (p<0.05) compared with the symptom-free group. Further, after logistic regression analysis corrected for age and gender, TM or PAI-1 levels above the 75th percentile were found significantly associated with a diagnosis of long-Covid (OR 2.156; 95% CI:1.24-3.75; p=0.007).
Conclusions: Our study shows the occurrence of an endotheliopathy in ongoing symptomatic long-Covid patients and supports the role of VTE in the long-Covid syndrome appearance.
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