Overlapping conditions in Long COVID at a multisite academic center

Stephanie L Grach; Daniel V Dudenkov; Beth Pollack; DeLisa Fairweather; Chris A Aakre; Bala Munipalli; Ivana T Croghan; Michael R Mueller; Joshua D Overgaard; Katelyn A Bruno; Nerissa M Collins; Zhuo Li; Ryan T Hurt; Michal C Tal; Ravindra Ganesh; Dacre T R Knight

doi:10.3389/fneur.2024.1482917

Overlapping conditions in Long COVID at a multisite academic center

Front Neurol. 2024 Oct 25:15:1482917. doi: 10.3389/fneur.2024.1482917. eCollection 2024.

Authors

Stephanie L Grach^#¹, Daniel V Dudenkov^#², Beth Pollack^#³, DeLisa Fairweather^#^{2

4

5

6}, Chris A Aakre¹, Bala Munipalli², Ivana T Croghan^{1

7}, Michael R Mueller¹, Joshua D Overgaard¹, Katelyn A Bruno^{2

8}, Nerissa M Collins¹, Zhuo Li⁹, Ryan T Hurt¹, Michal C Tal^{3

10}, Ravindra Ganesh¹, Dacre T R Knight²

Affiliations

¹ Division of General Internal Medicine, Mayo Clinic, Rochester, MN, United States.
² Department of General Internal Medicine, Mayo Clinic, Jacksonville, FL, United States.
³ Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States.
⁴ Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States.
⁵ Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States.
⁶ Department of Immunology, Mayo Clinic, Jacksonville, FL, United States.
⁷ Division of Quantitative Health Sciences, Rochester, MN, United States.
⁸ Department of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States.
⁹ Department of Biostatistics, Mayo Clinic, Jacksonville, FL, United States.
¹⁰ Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, United States.

^# Contributed equally.

Abstract

Background: Many patients experience persistent symptoms after COVID-19, a syndrome referred to as Long COVID (LC). The goal of this study was to identify novel new or worsening comorbidities self-reported in patients with LC.

Methods: Patients diagnosed with LC (n = 732) at the Mayo Long COVID Care Clinic in Rochester, Minnesota and Jacksonville, Florida were sent questionnaires to assess the development of new or worsening comorbidities following COVID-19 compared to patients with SARS-CoV-2 that did not develop LC (controls). Both groups were also asked questions screening for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), generalized joint hypermobility (GJH) and orthostatic intolerance. 247 people with LC (33.7%) and 40 controls (50%) responded to the surveys.

Results: In this study LC patients averaged 53 years of age and were predominantly White (95%) women (75%). The greatest prevalence of new or worsening comorbidities following SARS-CoV-2 infection in patients with LC vs. controls reported in this study were pain (94.4% vs. 0%, p < 0.001), neurological (92.4% vs. 15.4%, p < 0.001), sleep (82.8% vs. 5.3%, p < 0.001), skin (69.8% vs. 0%, p < 0.001), and genitourinary (60.6% vs. 25.0%, p = 0.029) issues. 58% of LC patients screened positive for ME/CFS vs. 0% of controls (p < 0.001), 27% positive for GJH compared to 10% of controls (p = 0.026), and a positive average score of 4.0 on orthostatic intolerance vs. 0 (p < 0.001). The majority of LC patients with ME/CFS were women (77%).

Conclusion: We found that comorbidities across 12 surveyed categories were increased in patients following SARS-CoV-2 infection. Our data also support the overlap of LC with ME/CFS, GJH, and orthostatic intolerance. We discuss the pathophysiologic, research, and clinical implications of identifying these conditions with LC.

Keywords: SARS-CoV-2; generalized joint hypermobility; hypermobile Ehlers-Danlos syndrome; mast cells; myalgic encephalomyelitis/chronic fatigue syndrome; orthostatic intolerance; pain; virus.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The statistical analysis for this study was supported by the UL1TR002377 internal grant to DVD. Components of this study were additionally supported by funding from the Mayo Clinic RACER Award to DRTK; Mayo Clinic STARDOM Award to DF and DRTK; Mayo Clinic’s Division of General Internal Medicine to DRTK, KAB, DF; the Ralph E. Pounds and Kathy Olesker Pounds Fund in Research Related to Chronic Pain to DF; American Heart Association 20TPA35490415 to DF; National Institutes of Health R01 HL164520, R21 AI154927, R21 AI152318, R21 AI145356 to DF, and R21 AI163302, R21 AI180863-91A1, AHA 23SCEFIA1153413, and DoD CDMRP PR210385 to KAB. Publication costs funded by Mayo Clinic Department of Medicine, Division of General Internal Medicine.