tetano
Editor, Senior Moderator
PLoS One
. 2022 Sep 29;17(9):e0275274.
doi: 10.1371/journal.pone.0275274. eCollection 2022.
Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study
Jennifer A Frontera[SUP] 1 [/SUP], Lorna E Thorpe[SUP] 2 [/SUP], Naomi M Simon[SUP] 3 [/SUP], Adam de Havenon[SUP] 4 [/SUP], Shadi Yaghi[SUP] 5 [/SUP], Sakinah B Sabadia[SUP] 1 [/SUP], Dixon Yang[SUP] 6 [/SUP], Ariane Lewis[SUP] 1 [/SUP], Kara Melmed[SUP] 1 [/SUP], Laura J Balcer[SUP] 1 7 [/SUP], Thomas Wisniewski[SUP] 1 8 [/SUP], Steven L Galetta[SUP] 1 7 [/SUP]
Affiliations
Abstract
Background: Post-acute sequelae of COVID-19 (PASC) includes a heterogeneous group of patients with variable symptomatology, who may respond to different therapeutic interventions. Identifying phenotypes of PASC and therapeutic strategies for different subgroups would be a major step forward in management.
Methods: In a prospective cohort study of patients hospitalized with COVID-19, 12-month symptoms and quantitative outcome metrics were collected. Unsupervised hierarchical cluster analyses were performed to identify patients with: (1) similar symptoms lasting ≥4 weeks after acute SARS-CoV-2 infection, and (2) similar therapeutic interventions. Logistic regression analyses were used to evaluate the association of these symptom and therapy clusters with quantitative 12-month outcome metrics (modified Rankin Scale, Barthel Index, NIH NeuroQoL).
Results: Among 242 patients, 122 (50%) reported ≥1 PASC symptom (median 3, IQR 1-5) lasting a median of 12-months (range 1-15) post-COVID diagnosis. Cluster analysis generated three symptom groups: Cluster1 had few symptoms (most commonly headache); Cluster2 had many symptoms including high levels of anxiety and depression; and Cluster3 primarily included shortness of breath, headache and cognitive symptoms. Cluster1 received few therapeutic interventions (OR 2.6, 95% CI 1.1-5.9), Cluster2 received several interventions, including antidepressants, anti-anxiety medications and psychological therapy (OR 15.7, 95% CI 4.1-59.7) and Cluster3 primarily received physical and occupational therapy (OR 3.1, 95%CI 1.3-7.1). The most severely affected patients (Symptom Cluster 2) had higher rates of disability (worse modified Rankin scores), worse NeuroQoL measures of anxiety, depression, fatigue and sleep disorder, and a higher number of stressors (all P<0.05). 100% of those who received a treatment strategy that included psychiatric therapies reported symptom improvement, compared to 97% who received primarily physical/occupational therapy, and 83% who received few interventions (P = 0.042).
Conclusions: We identified three clinically relevant PASC symptom-based phenotypes, which received different therapeutic interventions with varying response rates. These data may be helpful in tailoring individual treatment programs.
. 2022 Sep 29;17(9):e0275274.
doi: 10.1371/journal.pone.0275274. eCollection 2022.
Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study
Jennifer A Frontera[SUP] 1 [/SUP], Lorna E Thorpe[SUP] 2 [/SUP], Naomi M Simon[SUP] 3 [/SUP], Adam de Havenon[SUP] 4 [/SUP], Shadi Yaghi[SUP] 5 [/SUP], Sakinah B Sabadia[SUP] 1 [/SUP], Dixon Yang[SUP] 6 [/SUP], Ariane Lewis[SUP] 1 [/SUP], Kara Melmed[SUP] 1 [/SUP], Laura J Balcer[SUP] 1 7 [/SUP], Thomas Wisniewski[SUP] 1 8 [/SUP], Steven L Galetta[SUP] 1 7 [/SUP]
Affiliations
- PMID: 36174032
- PMCID: PMC9521913
- DOI: 10.1371/journal.pone.0275274
Abstract
Background: Post-acute sequelae of COVID-19 (PASC) includes a heterogeneous group of patients with variable symptomatology, who may respond to different therapeutic interventions. Identifying phenotypes of PASC and therapeutic strategies for different subgroups would be a major step forward in management.
Methods: In a prospective cohort study of patients hospitalized with COVID-19, 12-month symptoms and quantitative outcome metrics were collected. Unsupervised hierarchical cluster analyses were performed to identify patients with: (1) similar symptoms lasting ≥4 weeks after acute SARS-CoV-2 infection, and (2) similar therapeutic interventions. Logistic regression analyses were used to evaluate the association of these symptom and therapy clusters with quantitative 12-month outcome metrics (modified Rankin Scale, Barthel Index, NIH NeuroQoL).
Results: Among 242 patients, 122 (50%) reported ≥1 PASC symptom (median 3, IQR 1-5) lasting a median of 12-months (range 1-15) post-COVID diagnosis. Cluster analysis generated three symptom groups: Cluster1 had few symptoms (most commonly headache); Cluster2 had many symptoms including high levels of anxiety and depression; and Cluster3 primarily included shortness of breath, headache and cognitive symptoms. Cluster1 received few therapeutic interventions (OR 2.6, 95% CI 1.1-5.9), Cluster2 received several interventions, including antidepressants, anti-anxiety medications and psychological therapy (OR 15.7, 95% CI 4.1-59.7) and Cluster3 primarily received physical and occupational therapy (OR 3.1, 95%CI 1.3-7.1). The most severely affected patients (Symptom Cluster 2) had higher rates of disability (worse modified Rankin scores), worse NeuroQoL measures of anxiety, depression, fatigue and sleep disorder, and a higher number of stressors (all P<0.05). 100% of those who received a treatment strategy that included psychiatric therapies reported symptom improvement, compared to 97% who received primarily physical/occupational therapy, and 83% who received few interventions (P = 0.042).
Conclusions: We identified three clinically relevant PASC symptom-based phenotypes, which received different therapeutic interventions with varying response rates. These data may be helpful in tailoring individual treatment programs.