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Post-Acute Sequelae Patients with Severe COVID-19 History Show a Prolonged Inflammatory, Vascular Injury Pattern
Louisa Ruhl1, Isabell Pink2, Evgeny Chichelnitskiy1
1Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany.
European Journal of Immunology
|March 30, 2026
Summary
Severe COVID-19 survivors show lasting immune changes and inflammation markers up to a year later. These immune signatures correlate with impaired lung function and endothelial injury, contributing to long COVID symptoms.
Area of Science:
- Immunology
- Infectious Diseases
- Cardiovascular Research
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can cause persistent symptoms, known as long/post-COVID.
- The long-term effects of severe COVID-19 on immune responses, cardiovascular health, and pulmonary function remain incompletely understood, particularly in unvaccinated individuals.
Purpose of the Study:
- To investigate the sustained impact of severe COVID-19 on immune cell profiles, inflammatory markers, and autoantibodies up to 12 months post-discharge.
- To correlate these immunological changes with clinical parameters, including lung function and fatigue, in a longitudinal cohort of severe COVID-19 survivors.
Main Methods:
- A longitudinal cohort (LC) of 46 patients with prior severe COVID-19 (pre-vaccination) was followed for up to 12 months post-discharge.
- Immune cell profiles (T cell subsets, activation markers), SARS-CoV-2 antibodies, autoantigens, inflammatory chemokines, and cardiovascular markers were analyzed.
- Lung function and fatigue scores were assessed to determine long/post-COVID status, with comparisons to acute severe COVID-19 ICU patients and unexposed donors.
Main Results:
- Longitudinal cohort patients exhibited a sustained decrease in the CD4+/CD8+ T cell ratio and altered T cell differentiation and activation.
- Elevated plasma levels of chronic inflammation markers and indicators of endothelial injury persisted up to 1 year post-discharge.
- These inflammatory markers and autoantibodies against centromere structures showed a negative correlation with lung function.
Conclusions:
- Patients with a history of severe COVID-19 ICU admission display significant, long-lasting alterations in their immune profiles.
- These immune changes are characterized by persistent inflammation and endothelial injury, potentially contributing to the pathophysiology of long COVID.
- The findings highlight the need for further research into the long-term sequelae of severe SARS-CoV-2 infection and potential therapeutic targets.
Keywords:
autoantibodiesendothelial injuryimmune cell profileinflammationlong/post‐Covidsoluble immune mediatorsMore Related Videos
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