Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Intersections between Pneumonia, Lowered Oxygen Saturation Percentage and Immune Activation Mediate Depression, Anxiety and Chronic Fatigue Syndrome-like Symptoms due to COVID-19: A Nomothetic Network Approach

Version 1 : Received: 12 June 2021 / Approved: 14 June 2021 / Online: 14 June 2021 (13:01:31 CEST)

How to cite: Al-Jassas, H.; Al-Hakeim, H.; Maes, M. Intersections between Pneumonia, Lowered Oxygen Saturation Percentage and Immune Activation Mediate Depression, Anxiety and Chronic Fatigue Syndrome-like Symptoms due to COVID-19: A Nomothetic Network Approach. Preprints 2021, 2021060362 (doi: 10.20944/preprints202106.0362.v1). Al-Jassas, H.; Al-Hakeim, H.; Maes, M. Intersections between Pneumonia, Lowered Oxygen Saturation Percentage and Immune Activation Mediate Depression, Anxiety and Chronic Fatigue Syndrome-like Symptoms due to COVID-19: A Nomothetic Network Approach. Preprints 2021, 2021060362 (doi: 10.20944/preprints202106.0362.v1).

Abstract

Background: COVID-19 is associated with neuropsychiatric symptoms including increased depressive, anxiety and chronic fatigue-syndrome (CFS)-like physiosomatic (previously known as psychosomatic) symptoms.Aims: To delineate the associations between affective and CFS-like symptoms in COVID-19 and chest CT-scan anomalies (CCTAs), oxygen saturation (SpO2), interleukin (IL)-6, IL-10, C-Reactive Protein (CRP), albumin, calcium, magnesium, soluble angiotensin converting enzyme (ACE2) and soluble advanced glycation products (sRAGEs).Method: The above biomarkers were assessed in 60 COVID-19 patients and 30 heathy controls who had measurements of the Hamilton Depression (HDRS) and Anxiety (HAM-A) and the Fibromyalgia and Chronic Fatigue (FF) Rating Scales. Results: Partial Least Squares-SEM analysis showed that reliable latent vectors could be extracted from a) key depressive and anxiety and physiosomatic symptoms (the physio-affective or PA-core), b) IL-6, IL-10, CRP, albumin, calcium, and sRAGEs (the immune response core); and c) different CCTAs (including ground glass opacities, consolidation, and crazy paving) and lowered SpO2% (lung lesions). PLS showed that 70.0% of the variance in the PA-core was explained by the regression on the immune response and lung lesions latent vectors. Moreover, one common “infection-immune-inflammatory (III) core” underpins pneumonia-associated CCTAs, lowered SpO2 and immune activation, and this III core explains 70% of the variance in the PA core, and a relevant part of the variance in melancholia, insomnia, and neurocognitive symptoms.Discussion: Acute SARS-CoV-2 infection is accompanied by lung lesions and lowered SpO2 which both may cause activated immune-inflammatory pathways, which mediate the effects of the former on the PA-core and other neuropsychiatric symptoms due to SARS-CoV-2 infection.

Keywords

COVID-19; depression; chronic fatigue syndrome; inflammation; neuro-immune; psychiatry

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