Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study.
<h4>Background</h4>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 st...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2022-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0275274 |
| _version_ | 1811166145530560512 |
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| author | Jennifer A Frontera Lorna E Thorpe Naomi M Simon Adam de Havenon Shadi Yaghi Sakinah B Sabadia Dixon Yang Ariane Lewis Kara Melmed Laura J Balcer Thomas Wisniewski Steven L Galetta |
| author_facet | Jennifer A Frontera Lorna E Thorpe Naomi M Simon Adam de Havenon Shadi Yaghi Sakinah B Sabadia Dixon Yang Ariane Lewis Kara Melmed Laura J Balcer Thomas Wisniewski Steven L Galetta |
| author_sort | Jennifer A Frontera |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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).<h4>Conclusions</h4>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. |
| first_indexed | 2024-04-10T15:47:47Z |
| format | Article |
| id | doaj.art-c4bca48b0f3b4b329ab1f68795013f55 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-10T15:47:47Z |
| publishDate | 2022-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-c4bca48b0f3b4b329ab1f68795013f552023-02-12T05:31:05ZengPublic Library of Science (PLoS)PLoS ONE1932-62032022-01-01179e027527410.1371/journal.pone.0275274Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study.Jennifer A FronteraLorna E ThorpeNaomi M SimonAdam de HavenonShadi YaghiSakinah B SabadiaDixon YangAriane LewisKara MelmedLaura J BalcerThomas WisniewskiSteven L Galetta<h4>Background</h4>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.<h4>Methods</h4>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).<h4>Results</h4>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).<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0275274 |
| spellingShingle | Jennifer A Frontera Lorna E Thorpe Naomi M Simon Adam de Havenon Shadi Yaghi Sakinah B Sabadia Dixon Yang Ariane Lewis Kara Melmed Laura J Balcer Thomas Wisniewski Steven L Galetta Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study. PLoS ONE |
| title | Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study. |
| title_full | Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study. |
| title_fullStr | Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study. |
| title_full_unstemmed | Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study. |
| title_short | Post-acute sequelae of COVID-19 symptom phenotypes and therapeutic strategies: A prospective, observational study. |
| title_sort | post acute sequelae of covid 19 symptom phenotypes and therapeutic strategies a prospective observational study |
| url | https://doi.org/10.1371/journal.pone.0275274 |
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