Vamsi P. Guntur MD, MSc, Brian Modena MD, MSc, Claudia Onofrei MD, MSc, Shu-Yi Liao MD, MPH, ScD, Pearlanne Zelarney MS, Jared J. Eddy MD, MPhil, MSc, Rebecca Keith MD, Rachel DeCosta NP, Irina Petrache, MD**, Nir Goldstein, MD**
Introduction: With an increasing number of ambulatory visits for acute COVID-19 follow-up, we set out to characterize and identify clinical predictors of prolonged symptoms and antibody seroconversion. We hypothesized that patients who present with a high symptom burden are more likely to have prolonged post-acute sequelae of COVID-19 (PASC).
Methods: All adults with confirmed SARS-CoV-2 infection evaluated at a single ambulatory center between April–September 2020 were studied retrospectively using a logit model and ANOVA, and the importance of variables associated with prolonged symptoms and seroconversion was determined by machine learning methodology.
Results: The most common initial symptoms of 276 subjects were fatigue, dyspnea, cough, fever, and myalgia, with ~30% experiencing all five. Those with prolonged sequelae (>4 weeks; PASC) reported higher initial symptom burden compared to those without PASC (mean 8.2 vs. 3.3 symptoms, p < 0.0001). Anosmia (odds ratio, OR 23.0), myalgia (OR 12.8), and dyspnea (OR 10.8) had the highest predictive values for PASC. Neither lung function nor pre-existing lung disease correlated with PASC pulmonary symptoms (p = 0.17, p = 0.5, respectively). Natural post-COVID-19 seroconversion rate was 78%, with the male gender having higher- and corticosteroid treatment and elevated creatinine having lower seroconversion.
Conclusion: Ambulatory patients display a broad range of symptoms following acute COVID-19. A high initial symptom burden may predict PASC development. In unvaccinated, antibody seroconversion may be influenced by gender, corticosteroid use, and renal function.
Keywords: Ambulatory, SARS-CoV-2, Post-COVID-19, Post-acute sequelae of COVID-19 (PASC); lung disease; symptom burden; inhaled corticosteroids.
Article citation: Guntur VP, Modena B, Onofrei C, Liao SY, Zelarney P, Eddy JJ, Keith R, DeCosta R, Petrache I, Goldstein N. Predictive characteristics of prolonged symptoms and seroconversion in ambulatory patients recovering from SARS-CoV-2 infection. The Southwest Respiratory and Critical Care Chronicles 2022;10(44):1–9
From: 1Division of Pulmonary, Critical Care, and Sleep Medicine (VPG, CO, RK, RD, IP), Department of Medicine, National Jewish Health, Denver, CO; 2Division of Pulmonary Sciences and Critical Care Medicine (SYL, IP), Department of Medicine, University of Colorado, Anschutz Medical Campus, Denver, CO; 3Division of Occupational Medicine (SYL), Department of Medicine, NJH, Denver, CO; 4Colorado School of Public Health (SYL), University of Colorado, Anschutz Medical Campus, Denver, CO; 5The NJH Cohen Family Asthma Institute (VPG), NJH, Denver, CO; 6Scripps Institute(BM), La Jolla, CA; 7Division of Respiratory and Mycobacterial Infections (PZ, JJE), Department of Medicine NJH, Denver, CO
Submitted: 5/10/2022
Accepted: 7/1/2022
Conflicts of interest: none
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