Symptom Clusters in Adult Patients with Post-Acute COVID-19

Abstract

Background: As more reports emerge that many COVID-19 survivors suffer protracted and lingering symptoms, how to define and better characterize these patients with post-acute COVID-19 is a research challenge. To understand the overall symptom burden in patients with post-acute COVID-19, we explored whether identifiable symptom clusters exist in a cohort of patients with post-acute COVID-19 and then examined whether these clusters are associated with quality of life impairments. Methods: In a prospective observational study of COVID-19 patients at a Covid-19 Recovery (CORE) clinic between June and December 2020 (eligible patients had either a positive COVID-19 PCR or IgG antibody test), we administered a modified revised Edmonton Symptom Assessment survey which assessed whether patients had 13 symptoms over the week prior to presentation to the clinic on a scale of 0 (no symptoms) to 10 (most severe symptoms). We performed exploratory factor analysis to search for clustering of symptoms into factors and examined the relationship between these clusters and quality of life measures. Results: Across 127 adult patients treated at CORE (mean (standard deviation (SD) age 51.8 (14.0);73.2% were women. We found four symptom factors: emotional factor (including depression and anxiety), activity limiting factor (fatigue, sleepiness and shortness of breath), gastrointestinal symptom factor (nausea, appetite and taste changes) and pain factor (pain, neuropathy). The Cronbach's α for the individual factors ranged from 0.64-0.84. The emotional factor was associated with an increased odds of reporting worse emotional (Odds Ratio (95% Confidence Interval (95% CI) 1.9 (1.2-3.3) and worse cognitive health status (OR 4.9 (2.5-9.5);the activity limiting factor was associated with increase odds of worse physical health status (OR 4.5 (2.1-9.7);the gastrointestinal symptom factor was associated with increase odds of worse cognitive health status (OR 2.1 (1.1-4.2). Conclusions: We found four symptom factors in adult patients with post-acute COVID-19. There was strong internal correlation between the factors and the factors were associated with quality of life measures. Routine assessment of post-acute COVID-19 patient's emotional, gastrointestinal, pain and activity limiting symptoms is important as they may be associated with impaired health related quality of life.