National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, 100191, China.
School of Public Health, Peking University, Beijing, 100191, China.
Mol Psychiatry. 2023 Apr;28(4):1793-1801. doi: 10.1038/s41380-023-01951-1. Epub 2023 Jan 23.
Long-term sequelae clustering phenotypes are important for precise health care management in COVID-19 survivors. We reported findings for 1000 survivors 20 months after diagnosis of COVID-19 in a community-based cohort in China. Sequelae symptoms were collected from a validated questionnaire covering 27 symptoms involved in five organ systems including self-reported physical condition, dyspnea, cognitive function and mental health. The generalized symptoms were reported with the highest rate (60.7%), followed by the mental (48.3%), cardiopulmonary (39.8%), neurological (37.1%; cognitive impairment, 15.6%), and digestive symptoms (19.1%). Four clusters were identified by latent class analysis: 44.9% no or mild group (cluster 1), 29.2% moderate group with mainly physical impairment (cluster 2), 9.6% moderate group with mainly cognitive and mental health impairment (cluster 3), and 16.3% severe group (cluster 4). Physical comorbidities or history of mental disorders, longer hospitalization periods and severe acute illness predicted severe group. For moderate group, adults less than 60 years, with physical comorbidities and severe acute illness were more likely to have physical symptoms, while adult women with longer hospitalization stays had increased risk of cognitive and mental health impairment. Overall, among more than half of community COVID-19 survivors who presented moderate or severe sequelae 20 months after recovery, three-tenth had physical vulnerability that may require physical therapy aiming to improve functioning, one-tenth mental or cognitive vulnerable cases need psychotherapy and cognitive rehabilitation, and one-sixth severe group needs multidisciplinary clinical management. The remaining half is free to clinical intervention. Our findings introduced an important framework to map numerous symptoms to precise classification of the clinical sequelae phenotype and provide information to guide future stratified recovery interventions.
长期后遗症聚类表型对于 COVID-19 幸存者的精准医疗管理非常重要。我们在中国的一个社区队列中报告了 1000 名 COVID-19 确诊 20 个月后的幸存者的发现。后遗症症状是从一个经过验证的问卷中收集的,该问卷涵盖了五个器官系统的 27 种症状,包括自我报告的身体状况、呼吸困难、认知功能和心理健康。广义症状的报告率最高(60.7%),其次是精神(48.3%)、心肺(39.8%)、神经(37.1%;认知障碍,15.6%)和消化系统症状(19.1%)。通过潜在类别分析确定了四个聚类:44.9%无或轻度组(聚类 1)、29.2%主要为身体损伤的中度组(聚类 2)、9.6%主要为认知和心理健康损伤的中度组(聚类 3)和 16.3%严重组(聚类 4)。身体合并症或精神障碍史、较长的住院时间和严重急性疾病预测严重组。对于中度组,年龄小于 60 岁、有身体合并症和严重急性疾病的成年人更有可能出现身体症状,而住院时间较长的成年女性则有认知和心理健康损伤的风险增加。总体而言,在超过一半的社区 COVID-19 幸存者中,有 20 个月后出现中度或重度后遗症,其中十分之三的人身体脆弱,可能需要身体治疗以改善功能,十分之一的人精神或认知脆弱,需要心理治疗和认知康复,六分之一的严重组需要多学科临床管理。其余一半则无需临床干预。我们的研究结果为将大量症状映射到精确的临床后遗症表型分类提供了一个重要的框架,并为指导未来的分层康复干预提供了信息。
Cochrane Database Syst Rev. 2022-2-1
Br J Sports Med. 2013-1
Clin Microbiol Infect. 2020-9-23
J Acad Consult Liaison Psychiatry. 2022
Ann Intern Med. 2022-7
Quant Imaging Med Surg. 2025-5-1
Eur J Neurol. 2025-3
Biosaf Health. 2024-6-13
Med Rev (2021). 2024-7-2
Open Forum Infect Dis. 2025-1-30
Lancet Reg Health West Pac. 2025-1-21
Sci Bull (Beijing). 2022-11-30
Curr Med Res Opin. 2022-8
Nat Commun. 2022-4-12
Lancet Infect Dis. 2022-4