ABSTRACT
Introduction/Aim: Post COVID conditions are highly heterogenous and pose significant challenges to healthcare systems. The aim of this study was to identify and characterise symptom clusters at 6-months following COVID illness. Method(s): Symptom burden was assessed in a COVID respiratory clinic 6-months following diagnosis. K-mean cluster analysis was utilised to identify clusters and validated assessment tools for dyspnoea [MMRC], mood [PHQ-4], fatigue [FSS] and pain [WPI]were used to characterise clusters. Result(s): 58 patients (median age 59 years, 31 males) attended 6-month follow up. Cluster 4 represented patients experiencing high symptom burden with high fatigue, pain, depression and anxiety scores. A high proportion of Cluster 2 reported no symptoms but had high dyspnoea scores. Results for PHQ-4, FSS and WPI are presented as means (95%confidence interval) Cluster (n) Symptoms MMRC >1 (n%) PHQ-4 FSS WPI 1(8) anosmia, headache, fatigue, memory, concentration 3(5.1) 1(1,2) 31(17,45) 5(-1,10) 2(42) Isolated Dyspnoea 15(25.9) 1(1,2) 22(18,26) 1(0,1) 3(3) fatigue, nasal congestion, chest pain 3(5.1) 5(-10,21) 36(-26,98) 7(-11,24) 4(4) high symptom burden 4(6.9) 7(0,13) 51(36,66) 12(2,21) Conclusion(s): This exploratory analysis identified 4 possible post COVID condition phenotypes with unique symptom profiles. Larger scale phenotyping may facilitate a streamlined and customised approach to managing this evolving chronic and highly heterogenous clinical condition.
ABSTRACT
Introduction/Aim: As health systems emerge through successive waves of COVID-19, focus shifts to the management of Post-COVID-19 conditions. The aim of this prospective observational study was to characterise and evaluate the respiratory sequelae affecting patients 6-months post-diagnosis of COVID-19. SIGNFICANT MODELLING PREDICTORS Outcome Predictors MMRC>= 1 Disease severity Moderate: OR 16.5 +/- 1.02 (SE) p = 0.006 Impaired DLCO (%predicted) Disease severity B=-1.51+/-0.67 (SE) p = 0.010 Impaired TLC (%predicted) D-Dimer B= -0.305 +/- 0.001 (SE), p = 0.05 TLC below LLN Diabetes B=-1.28 +/- 0.32 (SE), p = 0.044 Methods: Patients were evaluated for symptom burden and lung function at 6-months post-diagnosis of COVID-19 in an outpatient setting. Result(s): Fifty-eight (45 inpatients and 13 outpatients;median age 59 years, 28 females) patients attended 6-month clinic appointment. Whilst nearly half (28,48.3%) were asymptomatic at 6-months, 24 (41.3%) patients reported a modified medical research council dyspnoea scale (MMRC) >= 1 and 21 (36.2%) patient-reported fatigue (n= 21, 36.2%). Reduced TLC (n= 11/50, 22.0%) and DLCO (n = 12/51, 23.5%) were common at 6-months. Results of predictive modelling analyses are described in adjacent table. Conclusion(s): Patients presenting with increased disease severity are at risk of persistent dyspnoea and impaired diffusion capacity, 6-months following acute COVID-19 illness. Research guided management of this growing at risk cohort, while paramount, poses a formidable challenge to stretched healthcare systems.
ABSTRACT
This was a single-centre, observational cohort study of inpatients admitted to Austin Health from March to October 2020, investigating demographic, clinical,laboratory and treatment parameters associated with readmission to hospital within 6 months following initial inpatient management of COVID-19. Of 169 patients admitted with COVID-19 between March and October 2020 who survived to discharge, 24 (14.2%) were readmitted to hospital within 6 months(median, 36 days;interquartile range, 15-67 days). Ten(5.9%) patients re-presented with respiratory or COVID-19-specific symptoms,five (3.0%) patients represented with COVID-19 complications, and nine (5.3%) patients represented with unrelated problems.In whole cohort analysis, increased length of stay during index admission was significantly associated with readmission (5 days vs 7 days,P=0.04).Anon-significant increase in readmission was noted inpatients with pre-existing chronic respiratory disease,patients requiring supplemental oxygen, and patients admitted to the intensive care unit (ICU).
ABSTRACT
Purpose: To estimate the prevalence of fibromyalgia (FM), 'fibromyalgianess' and fatigue six months following COVID-19 infection. Method: Consecutive consenting patients were recruited from a post-COVID-19 infection clinic. The following self-reported questionnaires were completed 6 months following COVID-19 infection: widespread pain index (WPI), symptom severity scale (SSS), 10-point visual analogue scale to assess fatigue severity (VAS-F) and 9-item, 7-point fatigue severity scale (FSS). The sum of SSS and WPI scores was used to calculate a polysymptomatic distress (PSD) score. FM was defined as per the 2016 revisions to the 2010/2011 American College of Rheumatology (ACR) criteria, and 'fibromyalgianess' was defined using polysymptomatic distress scale recognising the continuum of FM symptoms. Results: Of 25 study participants, the median age was 59 years (range 21-80), nine were female (36%) and 15 had been admitted to hospital for Covid-related complications (60%). Six months following infection, five met WPI and SSS criteria for fibromyalgia and three others had PSD scores >12 suggestive of severe symptoms;all were under 60 years. Problematic fatigue (mean FSS > 4) occurred in nine patients (36%) and although not statistically significant it was seen more frequently in females compared with males (56% vs 25%;95% CI -9% to 71%) and in those <60 years (46% vs 25%;CI -16% to 58%). Mean (± SD) FSS was 29.7 (± 15.0) and VAS-F was 6.0 (± 2.9). Compared to male patients, female patients demonstrated statistically significant higher mean WPI (8.0 vs 2.0), SSS (7.0 vs 2.1) and PSD (15.0 vs 4.1). Conclusion: Six months following COVID-19 infection, fibromyalgia, 'fibromyalgianess' and fatigue are common, with higher frequency in females and younger patients. This pattern parallels conventional fibromyalgia cohorts and may favour targeted service delivery. Further studies are needed to determine whether symptoms persist long-term.