Post-COVID-19 Syndrome: Retinal Microcirculation as a Potential Marker for Chronic Fatigue

• Published in: International journal of molecular sciences Vol. 23; no. 22; p. 13683
• Main Authors: Schlick, Sarah, Lucio, Marianna, Wallukat, Gerd, Bartsch, Alexander, Skornia, Adam, Hoffmanns, Jakob, Szewczykowski, Charlotte, Schröder, Thora, Raith, Franziska, Rogge, Lennart, Heltmann, Felix, Moritz, Michael, Beitlich, Lorenz, Schottenhamml, Julia, Herrmann, Martin, Harrer, Thomas, Ganslmayer, Marion, Kruse, Friedrich E, Lämmer, Robert, Mardin, Christian, Hohberger, Bettina
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 08.11.2022; MDPI
• Subjects: Age; Angiography; Autoantibodies; Bells; Biomarkers; Blood flow; Blood vessels; Cardiomyocytes; chronic fatigue; Chronic infection; Complications; Coronaviruses; COVID-19; COVID-19 - complications; Fatigue; Fatigue Syndrome, Chronic; Female; Fluorescein Angiography - methods; functional GPCR autoantibodies; G protein-coupled receptors; Gender; Glaucoma; Humans; Infections; long COVID syndrome; Male; Microcirculation; Neutrophils; Pandemics; Pathogenesis; Patients; Post-Acute COVID-19 Syndrome; post-COVID-19 syndrome; Prospective Studies; Respiratory diseases; Retina; retinal microcirculation; Retinal Vessels; SARS-CoV-2; Self report; Severe acute respiratory syndrome coronavirus 2; Sexually transmitted diseases; STD; Tomography, Optical Coherence - methods; Viral diseases; Womens health; COVID-19; functional GPCR autoantibodies; long COVID syndrome; OCT angiography; chronic fatigue; retinal microcirculation; chronic fatigue syndrome; post-COVID-19 syndrome
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms232213683

Post-COVID-19 syndrome (PCS) is characterized by persisting sequelae after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PCS can affect patients with all COVID-19 disease severities. As previous studies have revealed impaired blood flow as a provoking factor triggering PCS, it was the aim of the present study to investigate the potential association between self-reported chronic fatigue and retinal microcirculation in patients with PCS, potentially indicating an objective biomarker. A prospective study was performed, including 201 subjects: 173 patients with PCS and 28 controls. Retinal microcirculation was visualized by OCT angiography (OCT-A) and quantified using the Erlangen-Angio-Tool as macula and peripapillary vessel density (VD). Chronic fatigue (CF) was assessed according to the variables of Bell’s score, age and gender. VDs in the superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) were analyzed, considering the repetitions (12 times). Seropositivity for autoantibodies targeting G protein-coupled receptors (GPCR-AAbs) was determined by an established cardiomyocyte bioassay. Taking account of the repetitions, a mixed model was performed to detect possible differences in the least square means between the different groups included in the analysis. An age effect in relation to VD was observed between patients and controls (p < 0.0001). Gender analysis showed that women with PCS showed lower VD levels in the SVP compared to male patients (p = 0.0015). The PCS patients showed significantly lower VDs in the ICP as compared to the controls (p = 0.0001 (CI: 0.32; 1)). Moreover, considering PCS patients, the mixed model revealed a significant difference between those with chronic fatigue (CF) and those without CF with respect to VDs in the SVP (p = 0.0033 (CI: −4.5; −0.92)). The model included variables of age, gender and Bell’s score, representing a subjective marker for CF. Consequently, retinal microcirculation might serve as an objective biomarker in subjectively reported chronic fatigue in patients with PCS.