Konstantinos Eleftheriou

COVID-19, influenza, and respiratory syncytial virus are leading causes of severe acute respiratory infection (SARI). As viral dynamics shift post-pandemic, comparing their clinical profiles is essential for optimizing management and vaccination strategies. We conducted a retrospective observational study of adults hospitalized with PCR-confirmed COVID-19, influenza, or RSV over three consecutive seasons (2021–2024). We compared clinical features, comorbidities and outcomes, including mortality, intubation rates and respiratory deterioration. Multivariable analyses were performed where virus was the independent variable and respiratory deterioration, intubation rate and mortality, Charlson Comorbidity Index, smoking status and pneumonia were co-variates. 263 patients were analyzed. Key findings revealed distinct clinical profiles: influenza patients were significantly younger, while COVID-19 was the predominant cause of viral pneumonia. RSV patients presented with the most severe oxygenation deficit upon admission and experienced the highest rate of respiratory deterioration (28%). Logistic regression analyses demonstrated that pneumonia [OR 2.81, 95% Confidence Interval (CI): 1.23–6.43, p = 0.01] and RSV (OR 2.8, 95% CI: 1.16–6.63, p = 0.02) were independently associated with respiratory deterioration. Similarly, pneumonia (OR 4.86, 95%CI: 1.62–17.36, p < 0.01] and RSV (OR 4.67, 95%CI: 1.5–14.34, p < 0.01) were independently associated with high risk of intubation. Among patients hospitalized because of COVID-19, RSV and Influenza, pneumonia and RSV were linked with respiratory deterioration and increased risk of intubation but not with death.

Hypercoagulation is central to the pathogenesis of acute and post-acute COVID-19. This prospective observational study explored whether rotational thromboelastometry (ROTEM), a method that unveils coagulation status, predicts outcomes of hospitalized patients with COVID-19 pneumonia. We investigated 62 patients using ROTEM that was conducted at enrollment, clinical deterioration, discharge and follow-up visits 1 and 3 months post-discharge. A hypercoagulable ROTEM was more common at clinical deterioration than at enrollment and the levels of hypercoagulable ROTEM indices correlated with the clinical severity score. Hypercoagulable ROTEM at enrollment was not associated with in-hospital death. Patients with hypercoagulable ROTEM at enrollment, discharge and 1 month post-discharge had an increased risk of persistent symptoms 1 and 3 months after discharge. Patients with hypercoagulable ROTEM at enrollment, discharge, and 1 month after discharge were more likely to have lung diffusion capacity (DLco) impairment 3 months after discharge. High levels of hypercoagulable ROTEM indices were associated with the increased risk of persistent symptoms at later stages of the disease. In a multivariate analysis, (i) hypercoagulable ROTEM at discharge and female gender were linked to the presence of symptoms at one month post-discharge, (ii) hypercoagulable ROTEM at one month after discharge was linked to the presence of symptoms at three months post-discharge, (iii) hypercoagulable ROTEM at enrollment and at discharge and female gender were linked to the presence of impaired DLco at three months post-discharge. Excessive coagulation may contribute to long-COVID pathogenesis and ROTEM findings during hospitalization may predict post-acute-COVID-19 sequelae in patients with COVID-19-related pneumonia.

COVID-19 survivors commonly report persistent symptoms. In this observational study, we investigated the link between osteopontin (OPN) and post-acute COVID-19 symptoms and lung functional/imaging abnormalities. We recorded symptoms and lung imaging/functional data from previously hospitalized COVID-19 patients, who were followed for 4–84 weeks (122 patients/181 visits) post-symptom onset at our outpatient clinic. Circulating OPN was determined using ELISA. Plasma OPN levels were higher in symptomatic patients (compared with the asymptomatic ones); those with dyspnea (compared with those without dyspnea);those with a combination of serious symptoms, i.e., the presence of at least one of the following: dyspnea, fatigue and muscular weakness (compared with those with none of these symptoms); and those with dyspnea and m-MRC > 1 (compared with those with m-MRC = 0–1). Plasma OPN levels were inversely correlated with EQ-VAS (visual analog scale of the EQ-5D-5L health-related quality-of-life questionnaire) values. High-resolution CT or diffusion lung capacity (DLCO) findings were not related to circulating OPN. In the multiple logistic regression, the presence of symptoms, dyspnea, or the combination of serious symptoms were linked to female gender, increased BMI and pre-existing dyspnea (before the acute disease), while increased plasma OPN levels, female gender and pre-existing dyspnea with m-MRC > 1 were independently associated with severe post-COVID-19 dyspnea (m-MRC > 1). Using a correlation matrix to investigate multiple correlations between EQ-VAS, OPN and epidemiological data, we observed an inverse correlation between the OPN and EQ-VAS values. Increased circulating OPN was linked to the persistence of severe exertional dyspnea and impaired quality of life in previously hospitalized COVID-19 patients.

Introduction: The COVID-19 pandemic not only resulted in millions of hospitalizations but also created a need for follow-up of these pts. Our post-covid unit was established in our hospital in 04/2020 and since then more than 400 outpatients have been examined. Method: In this prospective observational study, we evaluated the clinical status, the lung function and imaging of 194 recovered COVID-19 patients, approximately 120 days after the onset of the symptoms (aos). The first visit occured 52,2 (SD 13,7) days aos and the second 115,4 (SD 15,3) days aos. 70% were male, aged 61,2 (SD 11,4) years old and 86% had at least one co-morbidity. Acute disease was non-severe in 30%, severe in 60% and critical in 10%. Results: Symptoms related to post-COVID-19 were reported in 62% at the first and in 30% at the second visit. Most common symptoms were dyspnea, fatigue and muscular weakness with a tendency to improve over time. Chest X-ray, performed 40,3 (SD 15,3) days aos, was normal in 48% and disclosed residual disease in 52%. Chest HRCT, performed 98,8 (SD 11,4) days aos, was normal in 38%, while in 62% had signs of residual disease (mainly mild or resolving lesions with approximately 12% having significant findings). PFTs performed 110,7 (SD 19,3) days aos. Mild reduction of DLco (between 60-80% of the predicted value) was observed in 38%, while moderate-severe (DLco lower than 60% of the predicted value) was observed in 16%. Conclusion: Observation on our post-COVID-19 cohort, revealed that although the majority of patients improve over time, 4 months after symptoms onset approximately 30% of them remain symptomatic, while 16% have significant functional respiratory burden and 12% significant imaging abnormalities.

Evidence to date suggests that a significant proportion of COVID-19 patients experience adverse psychological outcomes and neuropsychiatric complications. The aim of this study was to evaluate the effect of SARS-CoV-2 infection and subsequent hospitalization on the mental health, sleep, and quality of life of COVID-19 survivors. Patients were assessed 1–2 months after hospital discharge using standardized screening tools for depression and anxiety (HADS), post-traumatic stress disorder (IES-R), insomnia (AIS), and quality of life (EQ-5D-5L). Sociodemographic factors, comorbidities, disease severity and type of hospitalization were also collected. Amongst the 143 patients included, mental health symptoms were common (depression—19%; anxiety—27%; traumatic stress—39%; insomnia—33%) and more frequently reported in female than in male patients. Age, smoking status, comorbidities and illness severity were not found to significantly correlate with the presence of mood, sleep, or stress disorders. Finally, quality of life was worse for patients requiring ICU (p = 0.0057) or a longer hospital stay (p < 0.001) but was unaffected by factors such as sex and other measured outcomes. These findings highlight the need for appropriate intervention to properly manage the immediate and enduring mental health complications of COVID-19.