Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study
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. In a...
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| Veröffentlicht in: | PloS one 2022-09, Vol.17 (9), p.e0275274 |
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| creator | Frontera, Jennifer A Thorpe, Lorna E Simon, Naomi M de Havenon, Adam Yaghi, Shadi Sabadia, Sakinah B Yang, Dixon Lewis, Ariane Melmed, Kara Balcer, Laura J Wisniewski, Thomas Galetta, Steven L |
| description | 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.
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).
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 |
| doi_str_mv | 10.1371/journal.pone.0275274 |
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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).
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).
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0275274</identifier><identifier>PMID: 36174032</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Analysis ; Antidepressants ; Anxiety ; Biology and Life Sciences ; Cluster analysis ; Cognitive ability ; Complications ; Consent ; Coronaviruses ; COVID-19 ; COVID-19 - complications ; COVID-19 - therapy ; Datasets ; Disease Progression ; Fatigue ; Headache ; Headaches ; Hospitalization ; Humans ; Illnesses ; Infections ; Interviews ; Long COVID ; Medicine and Health Sciences ; Mental depression ; Observational studies ; Patients ; Phenotype ; Phenotypes ; Physical Sciences ; Prospective Studies ; Quality of life ; Regression analysis ; Research and Analysis Methods ; SARS-CoV-2 ; Severe acute respiratory syndrome coronavirus 2 ; Sleep disorders ; Subgroups ; Therapeutic applications ; Therapy ; Viral diseases</subject><ispartof>PloS one, 2022-09, Vol.17 (9), p.e0275274</ispartof><rights>COPYRIGHT 2022 Public Library of Science</rights><rights>2022 Frontera et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Frontera et al 2022 Frontera et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-4f867405ef50884751a9311e266367c639b218431a1fd7e86de047a69eb1960d3</citedby><cites>FETCH-LOGICAL-c692t-4f867405ef50884751a9311e266367c639b218431a1fd7e86de047a69eb1960d3</cites><orcidid>0000-0002-7155-8904 ; 0000-0002-0719-2522</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9521913/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9521913/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36174032$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Frontera, Jennifer A</creatorcontrib><creatorcontrib>Thorpe, Lorna E</creatorcontrib><creatorcontrib>Simon, Naomi M</creatorcontrib><creatorcontrib>de Havenon, Adam</creatorcontrib><creatorcontrib>Yaghi, Shadi</creatorcontrib><creatorcontrib>Sabadia, Sakinah B</creatorcontrib><creatorcontrib>Yang, Dixon</creatorcontrib><creatorcontrib>Lewis, Ariane</creatorcontrib><creatorcontrib>Melmed, Kara</creatorcontrib><creatorcontrib>Balcer, Laura J</creatorcontrib><creatorcontrib>Wisniewski, Thomas</creatorcontrib><creatorcontrib>Galetta, Steven L</creatorcontrib><title>Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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).
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).
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.</description><subject>Analysis</subject><subject>Antidepressants</subject><subject>Anxiety</subject><subject>Biology and Life Sciences</subject><subject>Cluster analysis</subject><subject>Cognitive ability</subject><subject>Complications</subject><subject>Consent</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - complications</subject><subject>COVID-19 - therapy</subject><subject>Datasets</subject><subject>Disease Progression</subject><subject>Fatigue</subject><subject>Headache</subject><subject>Headaches</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Illnesses</subject><subject>Infections</subject><subject>Interviews</subject><subject>Long COVID</subject><subject>Medicine and Health Sciences</subject><subject>Mental depression</subject><subject>Observational studies</subject><subject>Patients</subject><subject>Phenotype</subject><subject>Phenotypes</subject><subject>Physical Sciences</subject><subject>Prospective Studies</subject><subject>Quality of life</subject><subject>Regression analysis</subject><subject>Research and Analysis Methods</subject><subject>SARS-CoV-2</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Sleep disorders</subject><subject>Subgroups</subject><subject>Therapeutic applications</subject><subject>Therapy</subject><subject>Viral 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One</addtitle><date>2022-09-29</date><risdate>2022</risdate><volume>17</volume><issue>9</issue><spage>e0275274</spage><pages>e0275274-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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).
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).
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36174032</pmid><doi>10.1371/journal.pone.0275274</doi><tpages>e0275274</tpages><orcidid>https://orcid.org/0000-0002-7155-8904</orcidid><orcidid>https://orcid.org/0000-0002-0719-2522</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2022-09, Vol.17 (9), p.e0275274 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2719396964 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Analysis Antidepressants Anxiety Biology and Life Sciences Cluster analysis Cognitive ability Complications Consent Coronaviruses COVID-19 COVID-19 - complications COVID-19 - therapy Datasets Disease Progression Fatigue Headache Headaches Hospitalization Humans Illnesses Infections Interviews Long COVID Medicine and Health Sciences Mental depression Observational studies Patients Phenotype Phenotypes Physical Sciences Prospective Studies Quality of life Regression analysis Research and Analysis Methods SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 Sleep disorders Subgroups Therapeutic applications Therapy Viral diseases |
| title | Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study |
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