Immunological and clinical markers of post-acute sequelae of COVID-19: Insights from mild and severe cases six months post-infection

Abstract

Post-acute sequelae of COVID-19 (PASC) is a complex and multifaceted clinical challenge requiring to emphasize its underlying pathophysiological mechanisms. This study assessed hundreds of virological, serological, immunological, and tissue damage biomarkers in two patient cohorts who experienced mild (n=270) or severe (n=188) COVID-19, 6 to 9 months post-initial infection, and in which 40% and 57.4% of patients, respectively, developed PASC. Blood analysis showed that mains differences observed in humoral, viral, and biological biomarkers were associated with the initial COVID-19 severity, rather than being specifically linked to PASC. However, patients with PASC displayed altered CD4+ and CD8+ memory T-cell subsets, with higher cytokine-secreting cells and increased terminally differentiated CD45RA+ effector memory T cells (TEMRA). Elevated SARS-CoV-2-specific T cells responsive to nucleocapsid/membrane proteins with a TEMRA phenotype were also observed. A random forest model identified these features and initial symptom duration as top variables discriminating PASC, achieving over 80% classification accuracy. HighlightsO_LINine months post-initial SARS-CoV-2 infection, over 40% of patients developed PASC C_LIO_LIRegardless of PASC, the initial disease form influenced the main immune differences C_LIO_LIPASC led to altered memory T-cell subsets with elevated TEMRA phenotype C_LIO_LIPASC presence is associated with disease form, initial symptom count and duration C_LI