Long Covid Clinical Severity Types Based on Symptoms and Functional Disability: A Longitudinal Evaluation, 2024, Sivan et al

[EndME]

Long Covid Clinical Severity Types Based on Symptoms and Functional Disability: A Longitudinal Evaluation

Abstract
Background: Long Covid (LC) is a multisystem clinical syndrome with Functional Disability (FD) and compromised Overall Health (OH). There is a lack of distinct clinical symptom clusters (phenotypes) identified in LC so far but there is emerging information on LC clinical severity types. This study explores the consistency of these clinical severity types over time and the relationship between Symptom Severity (SS), FD, and OH in the context of the clinical severity types in a prospective sample.

Methods: A purposive sample of LC patients recruited to the LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION) study were assessed using the modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) at two assessment time points. A cluster analysis for clinical severity types was undertaken at both time points using k-means partition using two, three, and four initial clusters and different starting values. Cluster analysis was also carried out to assess the presence of symptom phenotypes (symptom clusters).

Findings: Cross-sectional data was available for 759 patients with 356 patients completing C19-YRSm at the two assessment points. Mean age was 46·8 years (SD = 12·7), 69·4% were females, and median duration of LC symptoms at first assessment was 360 days (IQR 217 to 703 days). Cluster analysis revealed three distinct SS and FD clinical severity types - mild (N=96), moderate (N=422), and severe (N=241) - with no distinct symptom phenotypes. The three-level clinical severity pattern remained consistent over time between the two assessments, with 51% of patients switching the clinical severity type between the assessments. The fluctuation was independent of the LC severity and time between the assessments.

Interpretation: This is the first study in the literature to show the consistency of the three clinical severity types over time with patients also switching between severity types indicating the fluctuating nature of LC.

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4642650

 

[SNT Gatchaman]

Preprint.

 

[Andy]

This team are so determined not to talk about ME/CFS - there is no mention of it at all other than obliquely.

"There is established evidence for PEM or PESE in the literature as a hallmark finding in LC and other post-viral illness. Relapse can be triggered by physical, cognitive, or emotional exertion, and evidence suggests that cognitive and emotional exertion can be equally responsible as much as physical exertion. Our study also suggested that fatigue and PEM are the symptoms most frequently experienced as severe (and occur most frequently with other severe symptoms)."

 

[rvallee]

In a paper exposing the poor rate of recovery, no less. I guess that other evidence for PEM in "other post-viral illness" just exists out there, detached from any data or group of patients. They even use the term PESE, which was introduced by the 2021 ME guidelines, was not used before then. And of course it's literally the defining feature of ME.

Oddly enough, they talk about about switching between severity types, which are not "revealed" in any sense of the word so much as this is just standard stratification, yet for the "mild" type they think that sending patients to the widely mocked "Your COVID recovery" and self-management is all well and good.

It's actually impressive to manage to simply make no mention of ME given this. This is the kind of discipline you find in dictatorships and cults, where "the thing" will never be mentioned. There are serious fundamental problems within medicine for this to happen, problems that cannot in any way be considered fringe or rare.

 

[NelliePledge]

“Other”
Ugh

 

[Trish]

Published 2024

Long COVID Clinical Severity Types Based on Symptoms andFunctional Disability: A Longitudinal Evaluation

Manoj Sivan 1,2,3,* , Adam B. Smith 4,5, Thomas Osborne 1, Madeline Goodwin 1, Román Rocha Lawrence 1,6,Sareeta Baley 7, Paul Williams 8, Cassie Lee 9, Helen Davies 10, Kumaran Balasundaram 11and Darren C. Greenwood 4,5 on behalf of the LOCOMOTION Consortium

1 Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK;t.osborne@leeds.ac.uk (T.O.); m.e.l.goodwin@leeds.ac.uk (M.G.); r.a.rochalawrence@leeds.ac.uk (R.R.L.)
2 COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds LS11 0DL, UK
3 National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust,Leeds LS7 4SA, UK
4 School of Medicine, University of Leeds, Leeds LS2 9JT, UK; a.b.smith@leeds.ac.uk (A.B.S.);d.c.greenwood@leeds.ac.uk (D.C.G.)
5 Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9JT, UK
6 ELAROS 24/7 Digital Company, Sheffield S1 2BJ, UK
7 Birmingham Community Healthcare NHS Trust, Birmingham B7 4BN, UK; s.baley@wlv.ac.uk
8 Hertfordshire Community NHS Trust, Welwyn AL6 9PW, UK; paul.williams80@nhs.net
9Imperial College Healthcare NHS Trust, London W2 1NY, UK; cassie.lee1@nhs.net
10 Cardiff and Vale University Hospitals NHS Trust, Cardiff CF14 4XW, UK; helen.davies30@wales.nhs.uk
11 NIHR Leicester Biomedical Research Centre—Respiratory & Infection Theme, Glenfield Hospital,Leicester LE3 9QP, UK; kumaran.balasundaram@uhl-tr.nhs.uk* Correspondence: m.sivan@leeds.ac.uk; Tel.: +44-1133922564

Abstract:
Background: Long COVID (LC) is a multisystem clinical syndrome with functionaldisability and compromised overall health. Information on LC clinical severity types is emerging incross-sectional studies. This study explored the pattern and consistency of long COVID (LC) clinicalseverity types over time in a prospective sample.

Methods: Participants with LC completed thecondition-specific outcome measure C19-YRSm (Yorkshire Rehabilitation Scale modified version) at two assessment time points. A cluster analysis for clinical severity types was undertaken at both time points using the k-means partition method.

Results: The study included cross-sectional data for759 patients with a mean age of 46.8 years (SD = 12.7), 69.4% females, and a duration of symptoms of 360 days (IQR 217 to 703 days). The cluster analysis at first assessment revealed three distinct clinical severity type clusters: mild (n = 96), moderate (n = 422), and severe (n = 241). Longitudinal data on 356 patients revealed that the pattern of three clinical severity types remained consistent over time between the two assessments, with 51% of patients switching clinical severity types between theassessments.

Conclusions: This study is the first of its kind to demonstrate that the pattern of three clinical severity types is consistent over time, with patients also switching between severity types,indicating the fluctuating nature of LC.