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All Studies   Meta Analysis    Recent:   

Distinct temporal trajectories and risk factors for Post-acute sequelae of SARS-CoV-2 infection

Chen et al., Frontiers in Medicine, doi:10.3389/fmed.2023.1227883
Oct 2023  
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PASC -32% Improvement Relative Risk PASC, ibuprofen -1% Acetaminophen  Chen et al.  EARLY TREATMENT  LONG COVID Does acetaminophen reduce the risk of long COVID (PASC)? Prospective study of 354 patients in the USA (May 2020 - Jun 2021) Higher PASC with acetaminophen (not stat. sig., p=0.067) c19early.org Chen et al., Frontiers in Medicine, Oct 2023 Favorsacetaminophen Favorscontrol 0 0.5 1 1.5 2+
1st treatment shown to increase risk in November 2020
 
*, now with p = 0.00000029 from 27 studies, but still recommended in 63 countries.
* From meta analysis with ≥3 studies.
4,300+ studies for 77 treatments. c19early.org
Prospective study of 494 COVID-19 patients showing higher risk of PASC with acetaminophen use in unadjusted results, without reaching statistical significance (p=0.07). Higher risk is also seen for dexamethasone and remdesivir (statistically significant for dexamethasone), however confounding by indication may be significant for these treatments, with increased use for more severe patients. While details of treatment timing and dose are not available, the result for acetaminophen can be compared with ibuprofen, with comparable indication for use. Notably there is no increased risk with ibuprofen, suggesting higher risk with acetaminophen, consistent with the higher risk seen in meta analysis1.
Acetaminophen is also known as paracetamol, Tylenol, Panadol, Calpol, Tempra, Calprofen, Doliprane, Efferalgan, Grippostad C, Dolo, Acamol, Fevadol, Crocin, and Perfalgan.
risk of PASC, 32.1% higher, RR 1.32, p = 0.07, treatment 98 of 232 (42.2%), control 39 of 122 (32.0%).
risk of PASC, 0.9% higher, RR 1.01, p = 1.00, treatment 16 of 41 (39.0%), control 121 of 313 (38.7%), ibuprofen.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Chen et al., 16 Oct 2023, prospective, USA, peer-reviewed, 17 authors, study period May 2020 - June 2021. Contact: jakris@uic.edu, charliekim@verily.com.
This PaperAcetaminophenAll
Distinct temporal trajectories and risk factors for Post-acute sequelae of SARS-CoV-2 infection
Chen Chen, Sairam Parthasarathy, Jacqueline M Leung, Michelle J Wu, Katherine A Drake, Vanessa K Ridaura, Howard C Zisser, William A Conrad, Victor F Tapson, James N Moy, Christopher R Defilippi, Ivan O Rosas, Bellur S Prabhakar, Mujeeb Basit, Mirella Salvatore, Jerry A Krishnan, Charles C Kim
Frontiers in Medicine, doi:10.3389/fmed.2023.1227883
Background: The understanding of Post-acute sequelae of SARS-CoV-2 infection (PASC) can be improved by longitudinal assessment of symptoms encompassing the acute illness period. To gain insight into the various disease trajectories of PASC, we assessed symptom evolution and clinical factors associated with the development of PASC over 3 months, starting with the acute illness period. Methods: We conducted a prospective cohort study to identify parameters associated with PASC. We performed cluster and case control analyses of clinical data, including symptomatology collected over 3 months following infection. Results: We identified three phenotypic clusters associated with PASC that could be characterized as remittent, persistent, or incident based on the 3-month change in symptom number compared to study entry: remittent (median; min, max: -4; -17, 3), persistent (-2; -14, 7), or incident (4.5; -5, 17) (p = 0.041 remittent vs. persistent, p < 0.001 remittent vs. incident, p < 0.001 persistent vs. incident). Despite younger age and lower hospitalization rates, the incident phenotype had a greater number of symptoms (15; 8, 24) and a higher proportion of participants with PASC (63.2%) than the persistent (6; 2, 9 and 52.2%) or remittent clusters (1; 0, 6 and 18.7%). Systemic corticosteroid administration during acute infection was also associated with PASC at 3 months [OR (95% CI): 2.23 (1.14, 4.36)]. Conclusion: An incident disease phenotype characterized by symptoms that were absent during acute illness and the observed association with high dose steroids during acute illness have potential critical implications for preventing PASC.
Ethics statement The studies involving humans were approved by the Study Protocol # 20201016 WCG Institutional Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Author contributions HZ, WC, and CK conceptualized the study. CC, KD, HZ, WC, VR, MB, and JK were involved in the study design. SP, VT, JM, CRd, IR, MB, MS, and JK recruited patients and collected the samples. CC, SP, JL, MW, and MS analyzed the data. CC, SP, JL, MW, MS, JK, and CK wrote the manuscript. CC, SP, JL, MW, KD, VR, HZ, WC, VT, JM, CRd, IR, BP, MB, MS, JK, and CK reviewed the manuscript. All authors contributed to the article and approved the submitted version. Conflict of interest CC, JL, MW, KD, and CK maintain equity ownership and employment at Verily Life Sciences. SP reports personal fees from Jazz Pharmaceuticals, Inc., and UpToDate, Inc., and grants from Philips, Inc., Sommetrics, Inc., and Regeneron. CRd serves on advisory boards for Abbott Diagnostics, Ortho/Quidel Diagnostics, and Roche Diagnostics. JK receives research funding from Regeneron. JK has also provided consulting for GlaxoSmithKline, AstraZeneca, CereVu Medical, Propeller/ResMed, and BData, Inc. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The..
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To gain insight into the various disease trajectories ' 'of PASC, we assessed symptom evolution and clinical factors associated with the development ' 'of PASC over 3 months, starting with the acute illness ' 'period.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We conducted a ' 'prospective cohort study to identify parameters associated with PASC. We performed cluster ' 'and case control analyses of clinical data, including symptomatology collected over 3 months ' 'following infection.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We ' 'identified three phenotypic clusters associated with PASC that could be characterized as ' 'remittent, persistent, or incident based on the 3-month change in symptom number compared to ' 'study entry: remittent (median; min, max: −4; −17, 3), persistent (−2; −14, 7), or incident ' '(4.5; −5, 17) (<jats:italic>p</jats:italic> = 0.041 remittent vs. persistent, ' '<jats:italic>p</jats:italic> &amp;lt; 0.001 remittent vs. incident, ' '<jats:italic>p</jats:italic> &amp;lt; 0.001 persistent vs. incident). Despite younger age and ' 'lower hospitalization rates, the incident phenotype had a greater number of symptoms (15; 8, ' '24) and a higher proportion of participants with PASC (63.2%) than the persistent (6; 2, 9 ' 'and 52.2%) or remittent clusters (1; 0, 6 and 18.7%). Systemic corticosteroid administration ' 'during acute infection was also associated with PASC at 3 months [OR (95% CI): 2.23 (1.14, ' '4.36)].</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>An incident ' 'disease phenotype characterized by symptoms that were absent during acute illness and the ' 'observed association with high dose steroids during acute illness have potential critical ' 'implications for preventing PASC.</jats:p></jats:sec>', 'DOI': '10.3389/fmed.2023.1227883', 'type': 'journal-article', 'created': { 'date-parts': [[2023, 10, 16]], 'date-time': '2023-10-16T15:18:54Z', 'timestamp': 1697469534000}, 'update-policy': 'http://dx.doi.org/10.3389/crossmark-policy', 'source': 'Crossref', 'is-referenced-by-count': 1, 'title': 'Distinct temporal trajectories and risk factors for Post-acute sequelae of SARS-CoV-2 infection', 'prefix': '10.3389', 'volume': '10', 'author': [ {'given': 'Chen', 'family': 'Chen', 'sequence': 'first', 'affiliation': []}, {'given': 'Sairam', 'family': 'Parthasarathy', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jacqueline M.', 'family': 'Leung', 'sequence': 'additional', 'affiliation': []}, {'given': 'Michelle J.', 'family': 'Wu', 'sequence': 'additional', 'affiliation': []}, {'given': 'Katherine A.', 'family': 'Drake', 'sequence': 'additional', 'affiliation': []}, {'given': 'Vanessa K.', 'family': 'Ridaura', 'sequence': 'additional', 'affiliation': []}, {'given': 'Howard C.', 'family': 'Zisser', 'sequence': 'additional', 'affiliation': []}, {'given': 'William A.', 'family': 'Conrad', 'sequence': 'additional', 'affiliation': []}, {'given': 'Victor F.', 'family': 'Tapson', 'sequence': 'additional', 'affiliation': []}, {'given': 'James N.', 'family': 'Moy', 'sequence': 'additional', 'affiliation': []}, {'given': 'Christopher R.', 'family': 'deFilippi', 'sequence': 'additional', 'affiliation': []}, {'given': 'Ivan O.', 'family': 'Rosas', 'sequence': 'additional', 'affiliation': []}, {'given': 'Bellur S.', 'family': 'Prabhakar', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mujeeb', 'family': 'Basit', 'sequence': 'additional', 'affiliation': []}, {'given': 'Mirella', 'family': 'Salvatore', 'sequence': 'additional', 'affiliation': []}, {'given': 'Jerry A.', 'family': 'Krishnan', 'sequence': 'additional', 'affiliation': []}, {'given': 'Charles C.', 'family': 'Kim', 'sequence': 'additional', 'affiliation': []}], 'member': '1965', 'published-online': {'date-parts': [[2023, 10, 16]]}, 'reference': [ { 'key': 'B1', 'doi-asserted-by': 'publisher', 'first-page': '713', 'DOI': '10.15585/mmwr.mm7121e1', 'article-title': 'Post–COVID conditions among adult COVID-19 survivors aged 18–64 and ≥65 ' 'Years–United States, March 2020–November 2021.', 'volume': '71', 'author': 'Bull-Otterson', 'year': '2022', 'journal-title': 'MMWR Morb Mortal Wkly Rep.'}, { 'key': 'B2', 'doi-asserted-by': 'crossref', 'DOI': '10.1038/s41467-021-26513-3', 'article-title': 'Burdens of post-acute sequelae of COVID-19 by severity of acute ' 'infection, demographics and health status.', 'volume': '12', 'author': 'Xie', 'year': '2021', 'journal-title': 'Nat Commun.'}, { 'key': 'B3', 'doi-asserted-by': 'crossref', 'first-page': '1122', 'DOI': '10.1126/science.abm8108', 'article-title': 'The immunology and immunopathology of COVID-19.', 'volume': '375', 'author': 'Merad', 'year': '2022', 'journal-title': 'Science.'}, { 'key': 'B4', 'doi-asserted-by': 'crossref', 'first-page': '268', 'DOI': '10.1016/j.it.2022.02.008', 'article-title': 'Early clues regarding the pathogenesis of long-COVID.', 'volume': '43', 'author': 'Peluso', 'year': '2022', 'journal-title': 'Trends Immunol.'}, { 'key': 'B5', 'year': '2022', 'journal-title': 'Department of Health and Human Services, Office of the Assistant ' 'Secretary for Health. 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'original-title': [], 'link': [ { 'URL': 'https://www.frontiersin.org/articles/10.3389/fmed.2023.1227883/full', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 10, 16]], 'date-time': '2023-10-16T15:19:03Z', 'timestamp': 1697469543000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.frontiersin.org/articles/10.3389/fmed.2023.1227883/full'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 10, 16]]}, 'references-count': 29, 'alternative-id': ['10.3389/fmed.2023.1227883'], 'URL': 'http://dx.doi.org/10.3389/fmed.2023.1227883', 'relation': {}, 'ISSN': ['2296-858X'], 'subject': ['General Medicine'], 'container-title-short': 'Front. Med.', 'published': {'date-parts': [[2023, 10, 16]]}}
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