Long COVID Clinical Phenotypes up to 6 Months After Infection Identified by Latent Class Analysis of Self-Reported Symptoms.

Autor: Gottlieb M; Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA., Spatz ES; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.; Department of Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA.; Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA., Yu H; Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut, USA.; Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA., Wisk LE; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA., Elmore JG; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA., Gentile NL; Post-COVID Rehabilitation and Recovery Clinic, Department of Family Medicine, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA., Hill M; Department of Emergency Medicine, UTHealth, Houston, Texas, USA., Huebinger RM; Department of Emergency Medicine, UTHealth, Houston, Texas, USA., Idris AH; Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Kean ER; Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Koo K; Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA., Li SX; Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA., McDonald S; Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.; Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA., Montoy JCC; Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA., Nichol G; Departments of Medicine and Emergency Medicine, University of Washington, Seattle, Washington, USA., O'Laughlin KN; Departments of Emergency Medicine and Global Health, University of Washington, Seattle, Washington, USA., Plumb ID; National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Rising KL; Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.; Center for Connected Care, Sidney Kimmel Medical School, Thomas Jefferson University, Philadelphia, Pennsylvania, USA., Santangelo M; Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA., Saydah S; National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA., Wang RC; Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA., Venkatesh A; Yale Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut, USA.; Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA., Stephens KA; Departments of Family Medicine, Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA., Weinstein RA; Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA.; Department of Internal Medicine, Cook County Hospital, Chicago, Illinois, USA.; The CORE Center, Chicago, Illinois, USA.
Jazyk: angličtina
Zdroj: Open forum infectious diseases [Open Forum Infect Dis] 2023 May 31; Vol. 10 (7), pp. ofad277. Date of Electronic Publication: 2023 May 31 (Print Publication: 2023).
DOI: 10.1093/ofid/ofad277
Abstrakt: Background: The prevalence, incidence, and interrelationships of persistent symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection vary. There are limited data on specific phenotypes of persistent symptoms. Using latent class analysis (LCA) modeling, we sought to identify whether specific phenotypes of COVID-19 were present 3 months and 6 months post-infection.
Methods: This was a multicenter study of symptomatic adults tested for SARS-CoV-2 with prospectively collected data on general symptoms and fatigue-related symptoms up to 6 months postdiagnosis. Using LCA, we identified symptomatically homogenous groups among COVID-positive and COVID-negative participants at each time period for both general and fatigue-related symptoms.
Results: Among 5963 baseline participants (4504 COVID-positive and 1459 COVID-negative), 4056 had 3-month and 2856 had 6-month data at the time of analysis. We identified 4 distinct phenotypes of post-COVID conditions (PCCs) at 3 and 6 months for both general and fatigue-related symptoms; minimal-symptom groups represented 70% of participants at 3 and 6 months. When compared with the COVID-negative cohort, COVID-positive participants had higher occurrence of loss of taste/smell and cognition problems. There was substantial class-switching over time; those in 1 symptom class at 3 months were equally likely to remain or enter a new phenotype at 6 months.
Conclusions: We identified distinct classes of PCC phenotypes for general and fatigue-related symptoms. Most participants had minimal or no symptoms at 3 and 6 months of follow-up. Significant proportions of participants changed symptom groups over time, suggesting that symptoms present during the acute illness may differ from prolonged symptoms and that PCCs may have a more dynamic nature than previously recognized. Clinical Trials Registration.  NCT04610515.
Competing Interests: Potential conflicts of interest. M. G. reports funding from the Rush Center for Emerging Infectious Diseases Research Grant, Emergency Medicine Foundation/Council of Residency Directors in Emergency Medicine Education Research Grant, Emergency Medicine: Reviews and Perspectives Medical Education Research Grant, University of Ottawa Department of Medicine Education Grant, and Society of Directors of Research in Medical Education Grant. E. S. S. receives grant funding from the National Institute on Minority Health and Health Disparities (U54MD010711-01), the US Food and Drug Administration to support projects within the Yale-Mayo Clinic Center of Excellence in Regulatory Science and Innovation (CERSI, U01FD005938), the National Institute of Biomedical Imaging and Bioengineering (R01EB028106-01), and the National Heart, Lung, and Blood Institute (R01HL151240). J. G. E. reports serving as Editor-in-Chief of Adult Primary Care topics for UpToDate. N. L. G. receives grant funding from the CDC (BAA75D301-20-75D30121C10207). A. V. reports funding for COVID-19–related studies from the Society of Academic Emergency Medicine Foundation Emerging Infectious Disease and Preparedness Grant, the Agency for Healthcare Research and Quality (R01 HS 28340-01), the Food and Drug Administration (ID: 75F40120C00174), and the Centers for Medicare and Medicaid Services. G. N. reports the following: funding for COVID-19–related studies from the National Institute of Allergy and Infectious Diseases (NIAID) (1R01AI66967), research funding from Abiomed, Vapotherm, and ZOLL Medical; consultant to CPR Therapeutics, Heartbeam Inc, Invero Health LLC, Kestra Medical Technologies, Orixha, and ZOLL Circulation; and reports a patent (Method for non-imaging ultrasound to measure blood flow during CPR) and nonprovisional patent (Method for modifying cell injury associated with reduced blood flow). K. N. O. reports funding for COVID-19–related studies from NIAID (1R01AI66967). K. L. R. reports funding for COVID-19–related studies from NIAID (1R01AI66967) and the Philadelphia Department of Public Health. All other authors report no potential conflicts.
(© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
Databáze: MEDLINE
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