Examining the relationship between inflammatory biomarkers during COVID-19 hospitalization and subsequent long-COVID symptoms: A longitudinal and retrospective study

Sykes, Dominic L.; Van der Feltz-Cornelis, Christina M.; Holdsworth, Luke; Hart, Simon P.; O'Halloran, Joseph; Holding, Steve; Crooks, Michael G.

Abstract

Introduction: Long-COVID is a heterogeneous condition with a litany of physical and neuropsychiatric presentations and its pathophysiology remains unclear. Little is known about the association between inflammatory biomarkers, such as interleukin-6 (IL-6) and C-reactive protein (CRP) in the acute phase, and persistent symptoms after hospitalization in COVID-19 patients. Methods: IL-6, CRP, troponin-T, and ferritin were analyzed at admission for all patients with COVID-19 between September 1, 2020 to January 10, 2021. Survivors were followed up 3-months following hospital discharge and were asked to report persistent symptoms they experienced. Admission data were retrospectively collected. Independent t-tests and Mann–Whitney U tests were performed. Results: In a sample of 144 patients (62.5% male, mean Age 62 years [SD = 13.6]) followed up 3 months after hospital discharge, the commonest symptoms reported were fatigue (54.2%), breathlessness (52.8%), and sleep disturbance (37.5%). In this sample, admission levels of IL-6, CRP and ferritin were elevated. However, those reporting myalgia, low mood, and anxiety at follow-up had lower admission levels of IL-6 (34.9 vs. 52.0 pg/mL, p =.043), CRP (83 vs. 105 mg/L, p =.048), and ferritin (357 vs. 568 ug/L, p =.01) respectively, compared with those who did not report these symptoms. Multivariate regression analysis showed that these associations were confounded by gender, as female patients had significantly lower levels of IL-6 and ferritin on admission (29.5 vs. 56.1, p =.03 and 421.5 vs. 589, p =.001, respectively) and were more likely to report myalgia, low mood and anxiety, when compared to males. Conclusions: Our data demonstrate that female patients present more often with lower levels of inflammatory biomarkers on admission which are subsequently associated with long-term post-COVID symptoms, such as myalgia and anxiety, in those discharged from hospital with severe COVID-19. Further research is needed into the role of serum biomarkers in post-COVID prognostication.

Citation

Sykes, D. L., Van der Feltz-Cornelis, C. M., Holdsworth, L., Hart, S. P., O'Halloran, J., Holding, S., & Crooks, M. G. (2023). Examining the relationship between inflammatory biomarkers during COVID-19 hospitalization and subsequent long-COVID symptoms: A longitudinal and retrospective study. Immunity, Inflammation and Disease, 11(10), Article e1052. https://doi.org/10.1002/iid3.1052

• Journal Article Type: Article
• Acceptance Date: Oct 4, 2023
• Online Publication Date: Oct 30, 2023
• Publication Date: Oct 1, 2023
• Deposit Date: Oct 31, 2023
• Publicly Available Date: Oct 31, 2023
• Journal: Immunity, Inflammation and Disease
• Electronic ISSN: 2050-4527
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 10
• Article Number: e1052
• DOI: https://doi.org/10.1002/iid3.1052
• Keywords: Biomarkers; COVID-19; Interleukin-6; Long-COVID
• Public URL: https://hull-repository.worktribe.com/output/4429280