Leitlinie S1: Long COVID: Differenzialdiagnostik und Behandlungsstrategien <span class="so-article-trans-title" dir="auto"> Translated title: Guideline S1: Long COVID: Diagnostics and treatment strategies </span>

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Abstract

Die vorliegende Leitlinie S1 fasst den Stand der Kenntnis zu Long COVID zum Zeitpunkt des Redaktionsschlusses zusammen. Aufgund der starken Dynamik der Wissensentwicklung versteht sie sich als „living guideline“. Der Schwerpunkt liegt auf der praktischen Anwendbarkeit auf der Ebene der hausärztlichen Primärversorgung, die als geeignete Stelle für den Erstzutritt und für die primäre Betreuung und Behandlung verstanden wird. Die Leitlinie gibt Empfehlungen zur Differenzialdiagnostik der häufigsten Symptome, die in der Folge einer Infektion mit SARS-CoV‑2 auftreten können, zu therapeutischen Optionen, zu Patient:innenführung und -betreuung, sowie zu Wiedereingliederung in den Alltag, und die Rehabilitation. Entsprechend des Krankheitsbildes ist die Leitlinie in einem interdisziplinären Prozess entstanden und gibt Empfehlungen zu Schnittstellen und Kooperationsmöglichkeiten.

Translated abstract

This guideline comprises the state of science at the time of the editorial deadline. In view of the high turnover of knowledge the guideline is designed as a living guideline. The main objective was to provide a tool for the use in primary care, being considered well suited as a first point of entry and for the provision of care. The guideline gives recommendations on the differential diagnosis of symptoms following SARS-CoV‑2 infection, on their therapeutic options, as well as for guidance and care of the patients concerned. It also offers advice concerning return to daily life and rehabilitation. Long COVID being a very variable condition, we chose an interdisciplinary approach.

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6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

Chaolin Huang, Lixue Huang, Yeming Wang … (2021)

Background The long-term health consequences of COVID-19 remain largely unclear. The aim of this study was to describe the long-term health consequences of patients with COVID-19 who have been discharged from hospital and investigate the associated risk factors, in particular disease severity. Methods We did an ambidirectional cohort study of patients with confirmed COVID-19 who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7, 2020, and May 29, 2020. Patients who died before follow-up, patients for whom follow-up would be difficult because of psychotic disorders, dementia, or re-admission to hospital, those who were unable to move freely due to concomitant osteoarthropathy or immobile before or after discharge due to diseases such as stroke or pulmonary embolism, those who declined to participate, those who could not be contacted, and those living outside of Wuhan or in nursing or welfare homes were all excluded. All patients were interviewed with a series of questionnaires for evaluation of symptoms and health-related quality of life, underwent physical examinations and a 6-min walking test, and received blood tests. A stratified sampling procedure was used to sample patients according to their highest seven-category scale during their hospital stay as 3, 4, and 5–6, to receive pulmonary function test, high resolution CT of the chest, and ultrasonography. Enrolled patients who had participated in the Lopinavir Trial for Suppression of SARS-CoV-2 in China received severe acute respiratory syndrome coronavirus 2 antibody tests. Multivariable adjusted linear or logistic regression models were used to evaluate the association between disease severity and long-term health consequences. Findings In total, 1733 of 2469 discharged patients with COVID-19 were enrolled after 736 were excluded. Patients had a median age of 57·0 (IQR 47·0–65·0) years and 897 (52%) were men. The follow-up study was done from June 16, to Sept 3, 2020, and the median follow-up time after symptom onset was 186·0 (175·0–199·0) days. Fatigue or muscle weakness (63%, 1038 of 1655) and sleep difficulties (26%, 437 of 1655) were the most common symptoms. Anxiety or depression was reported among 23% (367 of 1617) of patients. The proportions of median 6-min walking distance less than the lower limit of the normal range were 24% for those at severity scale 3, 22% for severity scale 4, and 29% for severity scale 5–6. The corresponding proportions of patients with diffusion impairment were 22% for severity scale 3, 29% for scale 4, and 56% for scale 5–6, and median CT scores were 3·0 (IQR 2·0–5·0) for severity scale 3, 4·0 (3·0–5·0) for scale 4, and 5·0 (4·0–6·0) for scale 5–6. After multivariable adjustment, patients showed an odds ratio (OR) 1·61 (95% CI 0·80–3·25) for scale 4 versus scale 3 and 4·60 (1·85–11·48) for scale 5–6 versus scale 3 for diffusion impairment; OR 0·88 (0·66–1·17) for scale 4 versus scale 3 and OR 1·77 (1·05–2·97) for scale 5–6 versus scale 3 for anxiety or depression, and OR 0·74 (0·58–0·96) for scale 4 versus scale 3 and 2·69 (1·46–4·96) for scale 5–6 versus scale 3 for fatigue or muscle weakness. Of 94 patients with blood antibodies tested at follow-up, the seropositivity (96·2% vs 58·5%) and median titres (19·0 vs 10·0) of the neutralising antibodies were significantly lower compared with at the acute phase. 107 of 822 participants without acute kidney injury and with estimated glomerular filtration rate (eGFR) 90 mL/min per 1·73 m2 or more at acute phase had eGFR less than 90 mL/min per 1·73 m2 at follow-up. Interpretation At 6 months after acute infection, COVID-19 survivors were mainly troubled with fatigue or muscle weakness, sleep difficulties, and anxiety or depression. Patients who were more severely ill during their hospital stay had more severe impaired pulmonary diffusion capacities and abnormal chest imaging manifestations, and are the main target population for intervention of long-term recovery. Funding National Natural Science Foundation of China, Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, and Peking Union Medical College Foundation.

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Persistent Symptoms in Patients After Acute COVID-19

Angelo Carfì, Roberto Bernabei, Francesco Landi (2020)

This case series describes COVID-19 symptoms persisting a mean of 60 days after onset among Italian patients previously discharged from COVID-19 hospitalization.

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Post-acute COVID-19 syndrome

Ani Nalbandian, Kartik Sehgal, Aakriti Gupta … (2021)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. As the population of patients recovering from COVID-19 grows, it is paramount to establish an understanding of the healthcare issues surrounding them. COVID-19 is now recognized as a multi-organ disease with a broad spectrum of manifestations. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged effects after acute COVID-19. Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of the current literature on post-acute COVID-19, its pathophysiology and its organ-specific sequelae. Finally, we discuss relevant considerations for the multidisciplinary care of COVID-19 survivors and propose a framework for the identification of those at high risk for post-acute COVID-19 and their coordinated management through dedicated COVID-19 clinics.

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Author and article information

Contributors

Susanne Rabady:

ORCID: http://orcid.org/0000-0002-3603-5841

susanne.rabady@kl.ac.at

Journal

Journal ID (nlm-ta): Wien Klin Wochenschr

Journal ID (iso-abbrev): Wien Klin Wochenschr

Title: Wiener Klinische Wochenschrift

Publisher: Springer Vienna (Vienna )

ISSN (Print): 0043-5325

ISSN (Electronic): 1613-7671

Publication date (Electronic): 1 December 2021

Publication date PMC-release: 1 December 2021

Pages: 1-42

Affiliations

[1 ]GRID grid.459693.4, Department Allgemeine Gesundheitsstudien, Kompetenzzentrum für Allgemein- und Familienmedizin, , Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, ; Dr. Karl-Dorrek-Straße 30, 3500 Krems, Österreich

[2 ]Pensionsversicherungsanstalt, Rehabilitationszentrum Großgmain, Großgmain, Österreich

[3 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Klinische Abteilung Phoniatrie-Logopädie, Universitätsklinik für Hals‑, Nasen- und Ohrenkrankheiten, , Medizinische Universität Wien, ; Wien, Österreich

[4 ]Neurologische Abteilung, Klinik Landstraße, Wiener Gesundheitsverbund, Wien, Österreich

[5 ]Abteilung für Kinder- und Jugendheilkunde, Klinik Ottakring, Wiener Gesundheitsverbund, Wien, Österreich

[6 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Unit Versorgungsforschung in der Primärversorgung, Zentrum für Public Health, , Medizinische Universität Wien, ; Wien, Österreich

[7 ]Praxis Dr. Hofbaur, Arbesbach, Österreich

[8 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Unit Health Services Research and Telemedicine in Primary Care, Department of Preventive- and Social Medicine, Center for Public Health, , Medical University of Vienna, ; Wien, Österreich

[9 ]Praxis Dr. Hoffmann-Dorninger, Wien, Österreich

[10 ]GRID grid.10253.35, ISNI 0000 0004 1936 9756, Abteilung für Pneumologische Rehabilitation, , Philipps Universität Marburg, ; Marburg, Deutschland

[11 ]Praxis Dr Oliver Lammel, Ramsau am Dachstein, Österreich

[12 ]GRID grid.473675.4, Klinik für Lungenheilkunde, , Kepler Universitätsklinikum, ; Linz, Österreich

[13 ]GRID grid.411904.9, ISNI 0000 0004 0520 9719, Universitätsklinik für Innere Medizin II, ; Innsbruck, Österreich

[14 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Universitätsklinik für Hals‑, Nasen- und Ohrenkrankheiten, , Medizinische Universität Wien, ; Wien, Österreich

[15 ]Ordination Dr. Stephanie Poggenburg, Hart bei Graz, Österreich

[16 ]Abteilung Psychiatrie und Psychotherapie, Pyhrn-Eisenwurzen-Klinikum, Steyr, Österreich

[17 ]Dermatologische Abteilung, Klinik Hietzing, Wiener Gesundheitsverbund, Wien, Österreich

[18 ]GRID grid.11598.34, ISNI 0000 0000 8988 2476, Universitätsklinik für Kinder- und Jugendheilkunde, , Medizinische Universität Graz, ; Graz, Österreich

[19 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Klinische Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, , Medizinische Universität Wien, ; Wien, Österreich

[20 ]GRID grid.22937.3d, ISNI 0000 0000 9259 8492, Klinische Abteilung für Sozialpsychiatrie, , Medizinische Universität Wien, ; Wien, Österreich

[21 ]GRID grid.459707.8, ISNI 0000 0004 0522 7001, Abteilung für Innere Medizin 2 (Kardiologie, Intensivmedizin), , Klinikum Wels-Grieskirchen, ; Wels, Österreich

[22 ]GRID grid.415431.6, ISNI 0000 0000 9124 9231, Klinikum Klagenfurt, ; Feschnigstraße 11, 9020 Klagenfurt, Österreich

[23 ]GRID grid.5361.1, ISNI 0000 0000 8853 2677, Univ.-Klinik für Innere Medizin II, , Medizinische Universität Innsbruck, ; Innsbruck, Österreich

[24 ]Ambulante internistische Rehabilitation, Therme Wien Med, Wien, Österreich

Author information

Susanne Rabady http://orcid.org/0000-0002-3603-5841

Markus Brose http://orcid.org/0000-0002-4902-4463

Kathryn Hoffmann http://orcid.org/0000-0001-8760-4250

Oliver Lammel http://orcid.org/0000-0003-0641-7678

Bernd Lamprecht http://orcid.org/0000-0003-3365-3449

Christian A. Müller http://orcid.org/0000-0001-6172-5417

Stefanie Poggenburg http://orcid.org/0000-0002-6233-3455

Hans Rittmannsberger http://orcid.org/0000-0002-6567-4677

Karin Vonbank http://orcid.org/0000-0003-2930-7252

Johannes Wancata http://orcid.org/0000-0003-4951-6780

Maria Wendler http://orcid.org/0000-0003-3660-5637

Article

Publisher ID: 1974

DOI: 10.1007/s00508-021-01974-0

PMC ID: 8633909

PubMed ID: 34851455

SO-VID: 04e550a7-8315-4dbc-b784-38bd71ec5f0c

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Leitlinie S1: Long COVID: Differenzialdiagnostik und Behandlungsstrategien Translated title: Guideline S1: Long COVID: Diagnostics and treatment strategies

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Novel Coronavirus Disease COVID-19

Most cited references 178

6-month consequences of COVID-19 in patients discharged from hospital: a cohort study

Persistent Symptoms in Patients After Acute COVID-19

Post-acute COVID-19 syndrome

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