Collin Simon M., Nikolaus Stephanie, Heron Jon, Knoop Hans, White Peter D., Crawley Esther, Chronic Fatigue Syndrome (CFS) symptombased phenotypes in two clinical cohorts of adult patients in the UK and The Netherlands,Journal of Psychosomatic Research(2015), doi: 10.1016/j.jpsychores.2015.12.006
Highlights
- •We explore chronic fatigue syndrome (CFS) phenotypes in two large clinical cohorts.
- •Adults with CFS may have one of 6 symptom-based phenotypes.
- •Phenotypes were associated with sex, duration of illness, and comorbidity.
- •Polysymptomatic patients had more severe illness and more comorbidities.
- •Phenotypes in UK patients were replicated in Dutch patients.
Abstract
Objective
Studies have provided evidence of heterogeneity within chronic fatigue syndrome (CFS), but few have used data from large cohorts of CFS patients or replication samples.
Methods
29 UK secondary-care CFS services recorded the presence/absence of 12 CFS-related symptoms; 8 of these symptoms were recorded by a Dutch tertiary service.
Latent Class Analysis (LCA) was used to assign symptom profiles (phenotypes).
Regression models were fitted with phenotype as outcome (in relation to age, sex, BMI, duration of illness) and exposure (in relation to comorbidities and patient-reported measures).
Results
Data were available for 7041 UK and 1392 Dutch patients.
Almost all patients in both cohorts presented with post-exertional malaise, cognitive dysfunction and disturbed/unrefreshing sleep, and these 3 symptoms were excluded from LCA. In UK patients, six phenotypes emerged: ‘full’ polysymptomatic (median 8, IQR 7-9 symptoms) 32.8%; ‘pain-only’ (muscle/joint) 20.3%; ‘sore throat/painful lymph node’ 4.5%; and ‘oligosymptomatic’ (median 1, IQR 0-2 symptoms) 4.7%.
Two ‘partial’ polysymptomatic phenotypes were similar to the ‘full’ phenotype, bar absence of dizziness/nausea/palpitations (21.4%) or sore throat/painful lymph nodes (16.3%).
Women and patients with longer duration of illness were more likely to be polysymptomatic.
Polysymptomatic patients had more severe illness and more comorbidities.
LCA restricted to 5 symptoms recorded in both cohorts indicated 3 classes (polysymptomatic, oligosymptomatic, pain-only), which were replicated in Dutch data.
Conclusions
Adults with CFS may have one of 6 symptom-based phenotypes associated with sex, duration and severity of illness, and comorbidity.
Future research needs to determine whether phenotypes predict treatment outcomes, and require different treatments.
Keywords:
Chronic fatigue syndrome, Latent class analysis, Phenotypes, Symptom profiles
Objective
Studies have provided evidence of heterogeneity within chronic fatigue syndrome (CFS), but few have used data from large cohorts of CFS patients or replication samples.
Methods
29 UK secondary-care CFS services recorded the presence/absence of 12 CFS-related symptoms; 8 of these symptoms were recorded by a Dutch tertiary service.
Latent Class Analysis (LCA) was used to assign symptom profiles (phenotypes).
Regression models were fitted with phenotype as outcome (in relation to age, sex, BMI, duration of illness) and exposure (in relation to comorbidities and patient-reported measures).
Results
Data were available for 7041 UK and 1392 Dutch patients.
Almost all patients in both cohorts presented with post-exertional malaise, cognitive dysfunction and disturbed/unrefreshing sleep, and these 3 symptoms were excluded from LCA. In UK patients, six phenotypes emerged: ‘full’ polysymptomatic (median 8, IQR 7-9 symptoms) 32.8%; ‘pain-only’ (muscle/joint) 20.3%; ‘sore throat/painful lymph node’ 4.5%; and ‘oligosymptomatic’ (median 1, IQR 0-2 symptoms) 4.7%.
Two ‘partial’ polysymptomatic phenotypes were similar to the ‘full’ phenotype, bar absence of dizziness/nausea/palpitations (21.4%) or sore throat/painful lymph nodes (16.3%).
Women and patients with longer duration of illness were more likely to be polysymptomatic.
Polysymptomatic patients had more severe illness and more comorbidities.
LCA restricted to 5 symptoms recorded in both cohorts indicated 3 classes (polysymptomatic, oligosymptomatic, pain-only), which were replicated in Dutch data.
Conclusions
Adults with CFS may have one of 6 symptom-based phenotypes associated with sex, duration and severity of illness, and comorbidity.
Future research needs to determine whether phenotypes predict treatment outcomes, and require different treatments.
Keywords:
Chronic fatigue syndrome, Latent class analysis, Phenotypes, Symptom profiles