Four subgroups can be distinguished within the post-covid syndrome

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Within the post-covid syndrome, four different subgroups can be distinguished, based on the type of symptoms. This is according to research published in JAMA, by Thaweethai et al., affiliated with the National Institute of Health in the United States.

The results stem from a large US prospective cohort study, the Recover study. For this sub-study, people were included who became infected between December 2021 and April 2023 or who did not become infected. Of the 9764 participants, 8646 (89%) met the WHO definition of SARS-CoV-2. 1118 (11%) participants had not experienced an infection. Everyone completed a questionnaire asking about 44 symptoms.

Twelve symptoms

When comparing these groups, twelve symptoms appeared to be most distinctive for post-covid syndrome: post-exertional malaise (PEM), fatigue, brain fog, dizziness, gastrointestinal complaints, palpitations, sexual problems, loss of smell and taste, thirst, chronic cough, chest pain and abnormal movements. Based on those symptoms, the researchers developed a post-covid score by assigning a certain value to each symptom. The score ranges from one to 25; the higher the score, the more symptoms. With a score of twelve or more, a person meets the definition of post-covid syndrome. 23 percent of covid-infected patients had symptoms above that threshold, as opposed to only 3.7 percent of those uninfected with covid-19.


The researchers then distinguished four subgroups of patients, based on their symptoms. One of those clusters includes patients with mainly loss of smell and taste. This cluster also appeared to have the least high score and was therefore less serious. A second cluster includes patients with PEM and fatigue. The third includes patients with brain fog, PEM and fatigue, and the fourth cluster of people with fatigue, PEM, dizziness, brain fog, gastrointestinal complaints and palpitations.

An accompanying editorial in JAMA mentions that many of the symptoms in the score show similarities to chronic fatigue syndrome/ME. The editorial also expresses the expectation that the definition of subgroups will provide starting points for research into the biological mechanisms of post-covid, and therefore also into the treatment.

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