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Kenny G, McCann K, O’Brien C, Savinelli S, Tinago W, Yousif O, Lambert JS, O’Broin C, Feeney ER, De Barra E, Doran P, Mallon PWG, Cotter A, Muldoon E, Sheehan G, McGinty T, Lambert JS, Green S, Leamy K, Kenny G, McCann K, McCann R, O’Broin C, Waqas S, Savinelli S, Feeney E, Mallon PWG, Garcia Leon A, Miles S, Alalwan D, Negi R, de Barra E, McConkey S, Hurley K, Sulaiman I, Horgan M, Sadlier C, Eustace J, Kelly C, Bracken T, Whelan B, Low J, Yousif O, McNicholas B, Courtney G, Gavin P. Identification of Distinct Long COVID Clinical Phenotypes Through Cluster Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2022; 9:ofac060. [PMID: 35265728 PMCID: PMC8900926 DOI: 10.1093/ofid/ofac060] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Background We aimed to describe the clinical presentation of individuals presenting with prolonged recovery from coronavirus disease 2019 (COVID-19), known as long COVID. Methods This was an analysis within a multicenter, prospective cohort study of individuals with a confirmed diagnosis of COVID-19 and persistent symptoms >4 weeks from onset of acute symptoms. We performed a multiple correspondence analysis (MCA) on the most common self-reported symptoms and hierarchical clustering on the results of the MCA to identify symptom clusters. Results Two hundred thirty-three individuals were included in the analysis; the median age of the cohort was 43 (interquartile range [IQR], 36–54) years, 74% were women, and 77.3% reported a mild initial illness. MCA and hierarchical clustering revealed 3 clusters. Cluster 1 had predominantly pain symptoms with a higher proportion of joint pain, myalgia, and headache; cluster 2 had a preponderance of cardiovascular symptoms with prominent chest pain, shortness of breath, and palpitations; and cluster 3 had significantly fewer symptoms than the other clusters (2 [IQR, 2–3] symptoms per individual in cluster 3 vs 6 [IQR, 5–7] and 4 [IQR, 3–5] in clusters 1 and 2, respectively; P < .001). Clusters 1 and 2 had greater functional impairment, demonstrated by significantly longer work absence, higher dyspnea scores, and lower scores in SF-36 domains of general health, physical functioning, and role limitation due to physical functioning and social functioning. Conclusions Clusters of symptoms are evident in long COVID patients that are associated with functional impairments and may point to distinct underlying pathophysiologic mechanisms of disease.
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Affiliation(s)
- Grace Kenny
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Kathleen McCann
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Conor O’Brien
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Stefano Savinelli
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Willard Tinago
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
| | - Obada Yousif
- Endocrinology Department, Wexford General Hospital, Carricklawn, Wexford, Ireland
| | - John S Lambert
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Infectious Diseases, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Cathal O’Broin
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoin R Feeney
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Eoghan De Barra
- Department of Infectious Diseases, Beaumont Hospital, Beaumont, Dublin, Ireland
- Department of International Health and Tropical Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Peter Doran
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Experimental Pathogen Host Research, University College Dublin, Dublin, Ireland
- Department of Infectious Diseases, St Vincent’s University Hospital, Elm Park, Dublin, Ireland
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Connellan D, Diffley K, McCabe J, Cotter A, McGinty T, Sheehan G, Ryan K, Cullen W, Lambert J, Callaly E, Kyne L. 484 CHANGING PRACTICES OF DECISION MAKING REGARDING DO-NOT-ATTEMPT-CARDIOPULMONARY-RESUSCITATION ORDERS AMID THE COVID-19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8344931 DOI: 10.1093/ageing/afab117.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation into focus. This study aims to analyse Do-Not-Attempt CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic.
Methods
This was a retrospective repeated cross-sectional study. Data including co-morbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from March 1st to May 31 s t 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID-19 admitted during the same period. Pre-COVID-19 pandemic DNACPR documentation rates were also examined. Factors associated with DNACPR order instatement during the first wave of the COVID-19 pandemic were identified.
Results
Of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. 50% of DNAR orders were recorded within 24 hours of a positive swab result for SARS-CoV-2. Of 131 patients aged 65 years or over within the cohort admitted with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 patients ≥65 without COVID-19 (p < 0.0001). During a comparable time period pre-pandemic, 15.4% of 130 older patients had a DNACPR order in place (p < 0.0001). Independent associations with DNACPR order documentation included increasing age (Odds Ratio [O.R.] 1.12; 95% CI 1.05-1.21); nursing home resident status (O.R. 3.57; 95% CI 1.02-12.50); frailty (O.R. 3.34; 95% CI 1.16-9.61) and chronic renal impairment (O.R. 5.49; 1.34-22.47). The case-fatality-rate of older patients with COVID-19 was 29.8% versus 5.4% without COVID-19. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived.
Conclusion
The COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case-fatality-rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain clinical practice despite the pandemic.
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Affiliation(s)
- D Connellan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - K Diffley
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - J McCabe
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - A Cotter
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - T McGinty
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - G Sheehan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - K Ryan
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - W Cullen
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - J Lambert
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - E Callaly
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
| | - L Kyne
- Mater Misericordiae University Hospital, Eccles Street, Dublin 7; School of Medicine, University College Dublin, Belfield, Dublin 4
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