To classify postacute sequelae of SARS-CoV-2 infection (PASC) as a new condition, symptom-based criteria must be identified, write authors of a prospective longitudinal cohort study. They develop a framework that can be tested in other investigations and refined iteratively to include other actionable clinical features.
Part of the NIH’s Researching COVID to Enhance Recovery (RECOVER) Initiative, this study considered self-reported symptoms and distinctive PASC subphenotypes with varying impacts on well-being and physical health. Recruited at 85 sites in 33 states, the District of Columbia, and Puerto Rico, participants enrolled before Apr. 10, 2023, completed a survey 6 months or more after acute symptom onset or test date.
“A total of 9,764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria,” the authors write. “Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2,231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months.”
Editorial: “An important strength of the RECOVER adult cohort’s initial analyses is the clustering of different symptoms into postacute sequelae phenotypes,” editorialists write. “Subgroupings of clusterings could lead to more fruitful future analyses of the biological mechanisms causing these symptoms and, ultimately, to intervention studies demonstrating differential effects of treatments that can return those affected back to health. Another potential benefit of the RECOVER adult cohort study would be if future work finds characteristic biomarkers for the different phenotypes of postacute sequelae, and if those signatures are similar to biosignatures in other conditions, particularly of myalgic encephalomyelitis/chronic fatigue syndrome. This would create an opportunity to conduct studies relevant to that complex disorder with sample sizes not previously feasible, accelerating the ability to rapidly test various treatment strategies for this previously identified disabling condition.”