Fatigue-dominant post-COVID clusters linked to poorer long-term outcomes

A multicentre observational cohort study published in BMC Medicine examined symptom patterns, healthcare utilisation and long-term outcomes in 1,155 adults referred to post-COVID outpatient clinics at three Dutch hospitals. Researchers used K-means clustering of symptoms reported at the initial visit. Participants were 67% female, with a median age of 50 years and median time since infection of 24.1 weeks. All were invited to complete a health-status and quality-of-life questionnaire after a mean 2.5 years.

Four clusters were identified: respiratory-dominant with dyspnoea (47.7%), fatigue-dominant with neurocognitive symptoms (27.6%), fatigue-dominant with multisystem symptoms (12.7%), and respiratory-dominant with airway-systemic symptoms (11.9%). Fatigue-dominant groups were more frequently referred to occupational therapy, speech and language therapy, mental health services or rehabilitation programmes (all p < 0.01). Respiratory-dominant groups more often received pharmacological treatment.

At follow-up, fatigue-dominant groups had worse patient-reported outcomes than respiratory-dominant groups. Anxiety and depression scores increased over time across all four clusters. These associations may inform assessment and referral planning, but do not establish that cluster-based care improves outcomes. The specialist-referred population may limit generalisability to community-managed patients. The supplied report does not provide follow-up response rates or numerical differences in outcome scores, limiting assessment of attrition and clinical effect sizes.