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.
Gottlieb, Michael; Spatz, Erica S.; Yu, Huihui; Wisk, Lauren E; Elmore, Joann G.; Gentile, Nicole L.; Hill, Mandy; Huebinger, Ryan M.; Idris, Ahamed H.; Kean, Efrat M.; Koo, Katherine; Li, Shu-Xia; McDonald, Samuel; Montoy, Juan Carlos C; Nichol, Graham; O'Laughlin, Kelli N.; Plumb, Ian D.; Rising, Kristin L.; Santangelo, Michelle; Saydah, Sharon; Wang, Ralph C.; Venkatesh, Arjun; Stephens, Kari A.; and Weinstein, Robert A., "Long COVID Clinical Phenotypes up to 6 Months After Infection Identified by Latent Class Analysis of Self-Reported Symptoms" (2023). Department of Emergency Medicine Faculty Papers. Paper 229.
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