Predictive characteristics of prolonged symptoms and seroconversion in ambulatory patients recovering from SARS-CoV-2 infection
Introduction: As an increasing number of patients present for ambulatory care following acute COVID-19, 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 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 and September 2020 were studied retrospectively using a logit model and ANOVA; the importance of variables associated with prolonged symptoms and seroconversion was determined using 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) 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 highest predictive values for prolonged sequelae. 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 male gender having higher and corticosteroid treatment and elevated creatinine having lower likelihood of seroconversion. Conclusion: Ambulatory PASC patients display a broad range of symptoms. A high initial symptom burden correlates with prolonged sequelae. In unvaccinated individuals, antibody seroconversion may be influenced by gender, corticosteroid use, and renal function.
Copyright (c) 2022 Vamsi Guntur, Brian Modena, Claudia Onofrei, Shu-Yi Liao, Pearlanne Zelarney, Jared Eddy, Rebecca Keith, Rachel DeCosta, Irina Petrache, Nir Goldstein
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