Imperial College London
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Peter Openshaw - Professor of Experimental Medicine

Faculty of Medicine, National Heart & Lung Institute

Proconsul, Professor of Experimental Medicine
 
 
 
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Contact

 

+44 (0)20 7594 3854p.openshaw Website CV

 
 
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Assistant

 

Ms Gale Lewis +44 (0)20 7594 0944

 
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Location

 

353Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@article{Millar:2022:10.1038/s41598-022-08032-3,
author = {Millar, JE and Neyton, L and Seth, S and Dunning, J and Merson, L and Murthy, S and Russell, CD and Keating, S and Swets, M and Sudre, CH and Spector, TD and Ourselin, S and Steves, CJ and Wolf, J and Docherty, AB and Harrison, EM and Openshaw, PJM and Semple, MG and Baillie, JK and ISARIC-4C},
doi = {10.1038/s41598-022-08032-3},
journal = {Scientific Reports},
title = {Distinct clinical symptom patterns in patients hospitalised with COVID-19 in an analysis of 59,011 patients in the ISARIC-4C study},
url = {http://dx.doi.org/10.1038/s41598-022-08032-3},
volume = {12},
year = {2022}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - COVID-19 is clinically characterised by fever, cough, and dyspnoea. Symptoms affecting other organ systems have been reported. However, it is the clinical associations of different patterns of symptoms which influence diagnostic and therapeutic decision-making. In this study, we applied clustering techniques to a large prospective cohort of hospitalised patients with COVID-19 to identify clinically meaningful sub-phenotypes. We obtained structured clinical data on 59,011 patients in the UK (the ISARIC Coronavirus Clinical Characterisation Consortium, 4C) and used a principled, unsupervised clustering approach to partition the first 25,477 cases according to symptoms reported at recruitment. We validated our findings in a second group of 33,534 cases recruited to ISARIC-4C, and in 4,445 cases recruited to a separate study of community cases. Unsupervised clustering identified distinct sub-phenotypes. First, a core symptom set of fever, cough, and dyspnoea, which co-occurred with additional symptoms in three further patterns: fatigue and confusion, diarrhoea and vomiting, or productive cough. Presentations with a single reported symptom of dyspnoea or confusion were also identified, alongside a sub-phenotype of patients reporting few or no symptoms. Patients presenting with gastrointestinal symptoms were more commonly female, had a longer duration of symptoms before presentation, and had lower 30-day mortality. Patients presenting with confusion, with or without core symptoms, were older and had a higher unadjusted mortality. Symptom sub-phenotypes were highly consistent in replication analysis within the ISARIC-4C study. Similar patterns were externally verified in patients from a study of self-reported symptoms of mild disease. The large scale of the ISARIC-4C study enabled robust, granular discovery and replication. Clinical interpretation is necessary to determine which of these observations have practical utility. We propose that four sub-phenotypes are usefully
AU  - Millar,JE
AU  - Neyton,L
AU  - Seth,S
AU  - Dunning,J
AU  - Merson,L
AU  - Murthy,S
AU  - Russell,CD
AU  - Keating,S
AU  - Swets,M
AU  - Sudre,CH
AU  - Spector,TD
AU  - Ourselin,S
AU  - Steves,CJ
AU  - Wolf,J
AU  - Docherty,AB
AU  - Harrison,EM
AU  - Openshaw,PJM
AU  - Semple,MG
AU  - Baillie,JK
AU  - ISARIC-4C
DO  - 10.1038/s41598-022-08032-3
PY  - 2022///
SN  - 2045-2322
TI  - Distinct clinical symptom patterns in patients hospitalised with COVID-19 in an analysis of 59,011 patients in the ISARIC-4C study
T2  - Scientific Reports
UR  - http://dx.doi.org/10.1038/s41598-022-08032-3
UR  - https://www.ncbi.nlm.nih.gov/pubmed/35478198
UR  - http://hdl.handle.net/10044/1/96631
VL  - 12
ER  -
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