Subphenotypes of self-reported symptoms and outcomes in long COVID: a prospective cohort study with latent class analysis.

Autor:	Kitsios GD; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA kitsiosg@upmc.edu.; Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Blacka S; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Jacobs JJ; Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Mirza T; Internal Medicine Residency Program, UPMC in Central Pa, Harrisburg, Pennsylvania, USA., Naqvi A; Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Gentry H; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Murray C; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Wang X; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Golubykh K; Internal Medicine Residency Program, UPMC in Central Pa, Harrisburg, Pennsylvania, USA., Qurashi H; Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Dodia A; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Risbano M; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Benigno M; Pfizer Inc, New York, New York, USA., Emir B; Pfizer Inc, New York, New York, USA., Weinstein E; Pfizer Inc, New York, New York, USA., Bramson C; Pfizer Inc, New York, New York, USA., Jiang L; Pfizer Inc, New York, New York, USA., Dai F; Pfizer Inc, New York, New York, USA., Szigethy E; Department of Psychiatry and Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Mellors JW; Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Methe B; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.; Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Sciurba FC; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.; Emphysema Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Nouraie SM; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Morris A; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.; Center for Medicine and the Microbiome, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2024 Mar 14; Vol. 14 (3), pp. e077869. Date of Electronic Publication: 2024 Mar 14.
DOI:	10.1136/bmjopen-2023-077869
Abstrakt:	Objective: To characterise subphenotypes of self-reported symptoms and outcomes (SRSOs) in postacute sequelae of COVID-19 (PASC). Design: Prospective, observational cohort study of subjects with PASC. Setting: Academic tertiary centre from five clinical referral sources. Participants: Adults with COVID-19 ≥20 days before enrolment and presence of any new self-reported symptoms following COVID-19. Exposures: We collected data on clinical variables and SRSOs via structured telephone interviews and performed standardised assessments with validated clinical numerical scales to capture psychological symptoms, neurocognitive functioning and cardiopulmonary function. We collected saliva and stool samples for quantification of SARS-CoV-2 RNA via quantitative PCR. Outcomes Measures: Description of PASC SRSOs burden and duration, derivation of distinct PASC subphenotypes via latent class analysis (LCA) and relationship with viral load. Results: We analysed baseline data for 214 individuals with a study visit at a median of 197.5 days after COVID-19 diagnosis. Participants reported ever having a median of 9/16 symptoms (IQR 6-11) after acute COVID-19, with muscle-aches, dyspnoea and headache being the most common. Fatigue, cognitive impairment and dyspnoea were experienced for a longer time. Participants had a lower burden of active symptoms (median 3 (1-6)) than those ever experienced (p<0.001). Unsupervised LCA of symptoms revealed three clinically active PASC subphenotypes: a high burden constitutional symptoms (21.9%), a persistent loss/change of smell and taste (20.6%) and a minimal residual symptoms subphenotype (57.5%). Subphenotype assignments were strongly associated with self-assessments of global health, recovery and PASC impact on employment (p<0.001) as well as referral source for enrolment. Viral persistence (5.6% saliva and 1% stool samples positive) did not explain SRSOs or subphenotypes. Conclusions: We identified three distinct PASC subphenotypes. We highlight that although most symptoms progressively resolve, specific PASC subpopulations are impacted by either high burden of constitutional symptoms or persistent olfactory/gustatory dysfunction, requiring prospective identification and targeted preventive or therapeutic interventions. Competing Interests: Competing interests: GDK has received research funding from Karius and Genentech, unrelated to this work. GDK, AM, JM, FCS and SMN have received funding from Pfizer.JWM is a consultant to Gilead Sciences, Inc. and has received grant funding from Gilead Sciences, Inc., to the University of Pittsburgh; receives compensation from Galapagos NV; and, holds share options in Galapagos NV, Infectious Disease Connect, Inc., and MingMed Biotechnology Co., Ltd., all unrelated to the current work. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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