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

• Published in: Open forum infectious diseases Vol. 10; no. 7; p. ofad277
• Main Authors: 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 R, 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, Weinstein, Robert A
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.07.2023
• Subjects: Major; COVID-19; phenotype; cluster; SARS-CoV-2; Long COVID
• ISSN: 2328-8957; 2328-8957
• DOI: 10.1093/ofid/ofad277

Abstract 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. This prospective study of 5963 participants identified 4 distinct phenotypes of post-COVID conditions at 3 and 6 months for both general and fatigue-related symptoms, with substantial class-switching over time. This suggests a more dynamic nature to post-COVID conditions than previously recognized.