Abstract Rationale Long-term sequelae of coronavirus disease 2019 (COVID-19), known as long COVID, present substantial heterogeneity in symptom persistence and recovery. Understanding the clinical subtypes of persistent symptoms may facilitate precision management. This study aimed to identify symptom-based subtypes among COVID-19 survivors and describe their longitudinal clinical, functional, and quality-of-life characteristics. Methods This single-center longitudinal cohort study included COVID-19 survivors discharged from Wuhan Jinyintan Hospital between January 7 and May 29, 2020. Participants were followed up face-to-face at 6 months, 1 year, 2 years, and 3 years after discharge. Follow-up assessments included a long COVID symptom questionnaire, functional scales, six-minute walk test (6MWT), and pulmonary function tests. Patients who completed all four follow-ups with consistent symptom data were analyzed. Hierarchical clustering using Ward’s method was applied to classify patients by symptom profiles. Between-cluster comparisons were conducted for symptom distribution, lung function, 6MWT distance, EQ-5D-5L scores, and healthcare utilization. Results A total of 1,024 patients completed all follow-ups, including 264 with persistent symptoms and 98 who fully recovered. Three distinct clusters were identified. Cluster 1 (n = 100) was characterized by fatigue and hair loss with gradual improvement over time. Cluster 2 (n = 112) showed fatigue, myalgia, arthralgia, sleep disturbance, and palpitations, with sustained symptom burden. Cluster 3 (n = 52), predominantly male, had fewer symptoms mainly involving sleep disturbance. Pulmonary function was highest in Cluster 3 (FEV1 and FVC, both P 0.01) and lowest in Cluster 2, which showed a declining trend. The 6MWT distance in Cluster 3 exceeded 520 m at 2 years, while Cluster 2 exhibited minimal recovery, particularly among females. mMRC and EQ-5D-5L scores indicated the greatest dyspnea and health burden in Cluster 2 and the best functional outcomes in Cluster 3. Cluster 2 had the highest outpatient and readmission rates. Female sex, older age, and COPD history were associated with lower odds of belonging to Cluster 3 (all P 0.01). Conclusion This study identified three persistent-symptom subtypes among COVID-19 survivors using hierarchical clustering. These subtypes demonstrate distinct clinical and functional trajectories, suggesting different underlying mechanisms and prognoses. Recognition of such subtypes may support targeted interventions and individualized management of long COVID. This abstract is funded by: None
Zhang et al. (Fri,) studied this question.