Post-COVID-19-Syndrom : Ein heterogenes Krankheitsbild aus der Sicht der Neurologie Post COVID-19 ConditionA Heterogeneous Clinical Picture from a Neurological Point of View

Mit dem Begriff Post-COVID-19-Syndrom werden nach WHO und den Leitlinien der deutschen Gesellschaft für Neurologie Symptome zusammengefasst, die in einem zeitlichen Zusammenhang nach einer COVID-19-Infektion auftreten, länger als drei Monate persistieren und keiner anderen Erkrankung zuzuordnen sind. Neben der meist im Vordergrund stehenden chronischen Erschöpfung sowie Beteiligung anderer Organsysteme werden auch neurologische und (neuro-)psychiatrische Symptome beschrieben. Risikofaktoren und zugrunde liegende pathophysiologische Mechanismen sind noch unzureichend geklärt, was die Diagnostik und Behandlung im Moment erschwert. Generell sind junge Frauen häufiger betroffen. Bei persistierenden neurologischen Symptomen wird eine ausführliche neurologische Untersuchung und die Durchführung einer symptomorientierten Zusatzdiagnostik empfohlen. Zumeist ergibt das konventionelle Organscreening keine pathologischen Befunde. Bisher liegen keine Therapieempfehlungen aus randomisierten Studien vor, sodass vorwiegend symptomorientierte Therapiekonzepte verfolgt werden. Viele Symptome verbessern sich über die Zeit, sodass ein aufklärendes Gespräch mit den Betroffenen ein zentraler Bestandteil des Therapiekonzepts darstellt. Ein interdisziplinärer multimodaler Therapieansatz sollte vor allem bei komplexen Krankheitsbildern angedacht werden.

Persistent somatic symptoms are key to individual illness perception at one year after COVID-19 in a cross-sectional analysis of a prospective cohort study

Objective Subjective illness perception (IP) can differ from physician's clinical assessment results. Herein, we explored patient's IP during coronavirus disease 2019 (COVID-19) recovery. Methods Participants of the prospective observation CovILD study (ClinicalTrials.gov: NCT04416100) with persistent somatic symptoms or cardiopulmonary findings one year after COVID-19 were analyzed (n = 74). Explanatory variables included demographic and comorbidity, COVID-19 course and one-year follow-up data of persistent somatic symptoms, physical performance, lung function testing, chest computed tomography and trans-thoracic echocardiography. Factors affecting IP (Brief Illness Perception Questionnaire) one year after COVID-19 were identified by regularized modeling and unsupervised clustering. Results In modeling, 33% of overall IP variance (R2) was attributed to fatigue intensity, reduced physical performance and persistent somatic symptom count. Overall IP was largely independent of lung and heart findings revealed by imaging and function testing. In clustering, persistent somatic symptom count (Kruskal-Wallis test: η2 = 0.31, p < .001), fatigue (η2 = 0.34, p < .001), diminished physical performance (χ2 test, Cramer V effect size statistic: V = 0.51, p < .001), dyspnea (V = 0.37, p = .006), hair loss (V = 0.57, p < .001) and sleep problems (V = 0.36, p = .008) were strongly associated with the concern, emotional representation, complaints, disease timeline and consequences IP dimensions. Conclusion Persistent somatic symptoms rather than abnormalities in cardiopulmonary testing influence IP one year after COVID-19. Modifying IP represents a promising innovative approach to treatment of post-COVID-19 condition. Besides COVID-19 severity, individual IP should guide rehabilitation and psychological therapy decisions.

Persistent somatic symptoms are key to individual illness perception at one year after COVID-19 in a cross-sectional analysis of a prospective cohort study.

OBJECTIVE: Subjective illness perception (IP) can differ from physician's clinical assessment results. Herein, we explored patient's IP during coronavirus disease 2019 (COVID-19) recovery. METHODS: Participants of the prospective observation CovILD study (ClinicalTrials.gov: NCT04416100) with persistent somatic symptoms or cardiopulmonary findings one year after COVID-19 were analyzed (n = 74). Explanatory variables included demographic and comorbidity, COVID-19 course and one-year follow-up data of persistent somatic symptoms, physical performance, lung function testing, chest computed tomography and trans-thoracic echocardiography. Factors affecting IP (Brief Illness Perception Questionnaire) one year after COVID-19 were identified by regularized modeling and unsupervised clustering. RESULTS: In modeling, 33% of overall IP variance (R2) was attributed to fatigue intensity, reduced physical performance and persistent somatic symptom count. Overall IP was largely independent of lung and heart findings revealed by imaging and function testing. In clustering, persistent somatic symptom count (Kruskal-Wallis test: η2 = 0.31, p < .001), fatigue (η2 = 0.34, p < .001), diminished physical performance (χ2 test, Cramer V effect size statistic: V = 0.51, p < .001), dyspnea (V = 0.37, p = .006), hair loss (V = 0.57, p < .001) and sleep problems (V = 0.36, p = .008) were strongly associated with the concern, emotional representation, complaints, disease timeline and consequences IP dimensions. CONCLUSION: Persistent somatic symptoms rather than abnormalities in cardiopulmonary testing influence IP one year after COVID-19. Modifying IP represents a promising innovative approach to treatment of post-COVID-19 condition. Besides COVID-19 severity, individual IP should guide rehabilitation and psychological therapy decisions.