Symptom scoring framework helps formalize definition of COVID-19 over time

Researchers analyzed self-reported symptoms across multiple organ systems present at more than 6 months post-infection to identify acute sequelae of SARS-CoV-2 infection (PASC), also known as long-term coronavirus. It has taken steps to formally identify it as a new disease. .

This research JAMAexamined data from 9,764 patients who participated in the National Institutes of Health’s Novel Coronavirus Research for Enhanced Recovery (RECOVER) initiative, including 8,646 who were infected with SARS-CoV-2.¹ Researchers identified 37 symptoms that appeared more frequently after COVID-19, with a frequency of 2.5% or more and an adjusted odds ratio of 1.5 or more.

A composite scoring framework for identifying PASC included 12 symptoms. Symptoms include post-exercise malaise, fatigue, foggy head, dizziness, gastrointestinal symptoms, palpitations, altered sexual desire or ability, loss or altered sense of smell or taste, dry mouth, chronic cough, chest pain and abnormal movements. is included. Each symptom is assigned a value to determine a composite PASC score, with higher scores indicating worse health.

“A framework for identifying PASC cases based on symptoms is the first step towards defining PASC as a new condition. Iterative refinement to incorporate more features is needed,” write the authors, led by Dr. Thanayott Taweetai of Massachusetts General Hospital and Harvard Medical School.

Participants were enrolled in the study in 33 states, Washington, DC, and Puerto Rico. A total of 71% of study participants were women. 16% Hispanic/Latino. 15% are non-Hispanic blacks. Median age was 47 years.

Overall, 1990 (23%) of all infected participants scored positive for PASC, and 41 (3.7%) of 1118 uninfected participants tested positive for PASC. The most common symptoms were post-exercise malaise reported in 87% of PASC-positive participants, malaise (85%), foggy head (64%), dizziness (62%), gastrointestinal (59%) ) and palpitations (57%).

The researchers reported results in three sub-cohorts: acute omicron, pre-acute omicron, and post-acute omicron. Of these, 2,231 had their first SARS-CoV-2 infection after 1 December 2021 and were enrolled in the study within 30 days. The study identified 224 (10%) as PASC-positive at 6 months based on the symptom framework.

Participants who were infected before the Omicron variant of SARS-CoV-2 predominated were more likely to be PASC-positive with more severe symptoms, and 35% of participants in the pre-acute Omicron subgroup % were scored as PASC positive. However, the authors noted that previously infected individuals may have been more likely to enroll in RECOVER for PASC. Those who had repeated infections during the Omicron era were more likely to be PASC-positive, and vaccination was associated with a modest reduction in PASC.

“Given the heterogeneity of PASC symptoms, it is important to determine whether PASC represents one unified condition or reflects a unique phenotypic group,” the authors wrote. there is “Recent evidence supports the existence of the PASC phenotype, but the characterization of these phenotypes is inconsistent and heavily reliant on available data.”

Limitations of this study include that the symptoms included in the framework may not reflect the impact of other symptoms, that symptoms may have influenced study participation, and that uninfected participants There is likely to be a selection bias as patients may have had previous asymptomatic infections.

The authors described the PASC scoring system as a starting point for further investigation, pointing out that the definition of PASC’s classification rules requires more detailed algorithms incorporating biological features.

“This study demonstrates the benefits of multidisciplinary collaboration based on extensive input from patient representatives,” said Robert Gross, MD, MSCE and Vincent Lo Re III, MD, MSCE, in editorial comments.² “This work continues to be necessary to determine whether this phenomenon represents a single entity with a single definition, or multiple phenotypes following COVID-19 that require separate case definitions.” becomes. from a few more [from one, many]). A stronger study to address this question and finalize the definition of these acute sequelae will ultimately lead to higher quality care and treatment for patients with late complications of SARS-CoV-2 infection. should be promoted. “

This article originally appeared on Contagion Live.

References

1. Thaweethai T, Jolley SE, Karlson EW, et al. Development of a definition of acute sequelae of SARS-CoV-2 infection. jam. Published online May 25, 2023. doi: 10.1001/jama.2023.8823.

2. Gross R, Lo Re V. Elucidating acute sequelae of SARS-CoV-2: From one to many (one to many). jam. Published online May 25, 2023. doi: 10.1001/jama.2023.8961.