What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Post-acute sequelae of SARS-CoV-2 (PASC) / Long COVID (n=2314). Intervention: Hospitalization for acute COVID-19 vs. No hospitalization for acute COVID-19. Primary outcome: COMPASS-31 total score (p=0.06).

What does this research mean for the field?

Moderate to severe autonomic dysfunction is present in approximately 66% of patients with long COVID, and its severity is independent of whether the patient was hospitalized during their acute COVID-19 infection. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 19, 2022Open Access

Characterization of autonomic symptom burden in long COVID: A global survey of 2,314 adults

Key Result

Moderate to severe autonomic dysfunction was present in 66% of patients with long COVID, with symptom severity independent of acute COVID-19 hospitalization status.

Study Design

Type

Cross-Sectional (n=2,314)

Multicenter

Yes

Structured PICO

Population

2,314 adults ages 18-64 years with post-acute sequelae of SARS-CoV-2 (PASC)/long COVID (symptoms persisting beyond 30 days), including test-confirmed (n=1,249) and test-unconfirmed (n=1,065) participants. Multinational (34 countries, mostly USA 77.6%), mostly female (87.3%), white (89.5%).

Outcome

Composite Autonomic Symptom 31 (COMPASS-31) total scorepatient reported

Moderate to severe autonomic dysfunction is highly prevalent in patients with long COVID, independent of the severity of their acute COVID-19 illness.

Main Result

Absolute Event Rate: 28.95% vs 26.4%

p-value: p=0.06

Limitations

Study population limited to English speakers with access to social media support groups
Lack of diversity, as most participants were white
Self-reported variables are subject to information bias and misclassification
Lack of a control group and baseline measures
Selection bias from recruiting via long-COVID support groups
COMPASS-31 was designed to assess autonomic failure and is less specific for other forms of autonomic dysfunction
Lack of confirmed-positive COVID test results in all patients

Abstract

Background Autonomic dysfunction is a known complication of post-acute sequelae of SARS-CoV-2 (PASC)/long COVID, however prevalence and severity are unknown. Objective To assess the frequency, severity, and risk factors of autonomic dysfunction in PASC, and to determine whether severity of acute SARS-CoV-2 infection is associated with severity of autonomic dysfunction. Design Cross-sectional online survey of adults with PASC recruited through long COVID support groups between October 2020 and August 2021. Participants 2,413 adults ages 18–64 years with PASC including patients who had a confirmed positive test for COVID-19 (test-confirmed) and participants who were diagnosed with COVID-19 based on clinical symptoms alone. Main measures The main outcome measure was the Composite Autonomic Symptom 31 (COMPASS-31) total score, used to assess global autonomic dysfunction. Test-confirmed hospitalized vs. test-confirmed non-hospitalized participants were compared to determine if the severity of acute SARS-CoV-2 infection was associated with the severity autonomic dysfunction. Key results Sixty-six percent of PASC patients had a COMPASS-31 score 20, suggestive of moderate to severe autonomic dysfunction. COMPASS-31 scores did not differ between test-confirmed hospitalized and test-confirmed non-hospitalized participants 28.95 (15.62, 46.60) vs. 26.4 (13.75, 42.10); p = 0.06. Conclusions Evidence of moderate to severe autonomic dysfunction was seen in 66% of PASC patients in our study, independent of hospitalization status, suggesting that autonomic dysfunction is highly prevalent in the PASC population and independent of the severity of acute COVID-19 illness.

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