{
  "abstract": "It is important to determine whether the persistent cognitive and fatigue complaints, as part of post-acute sequelae of COVID-19 (PASC), are associated with underlying patterns and specific symptoms clusters. Therefore, the aim of the present study was to investigate symptom clusters and clinical phenotypes in PASC. We included n = 153 individuals (53 years old, 66% female, 2 years post SARS-CoV-2 infection) categorized into groups with (n = 88) and without (n = 65) PASC, defined by severe fatigue and concentration problems using validated cut-offs. Symptom clusters (i.e., component loadings and component scores) were identified using principal component analyses (PCA, eigenvalue[EV]>1.0), using clinical, somatic, coping and sleep factors, symptom severity, neuropsychological and physical tests (totalling 19 tests and questionnaires). We then used logistic regression techniques on (participant-level) component scores (standardized) to investigate associations with PASC. Finally, K-means clustering methods to identify clinical phenotypes. Analyses were adjusted for age, sex, education, nationality and time since infection. PCA identified 5 components, explaining 70% of the variance. We labelled these components as follows: (1) PEM, ME/CFS and sleep symptoms, coping factors (EV = 7.0, 36.9% variance), (2) information-processing speed (EV = 2.5, 13.3%), (3) executive functioning (EV = 1.5, 8.0%, (4) physical performance (EV = 1.2, 6.5%), (5) somatic comorbidities and hospital admission (EV = 1.0, 5.5%). Logistic regression showed that only the first component scores (Odds ratio [95% confidence interval] = 97.1 [16.5–570.3], p < 0.001,), and none of the others (all p > 0.05), associated with PASC. Cluster analysis revealed two distinct clinical phenotypes among individuals with severe chronic fatigue: one marked by physical impairment and the other by diminished cognitive performance. Consistent with existing literature, we confirmed that PASC is a heterogeneous syndrome marked by extensive, interrelated symptoms. Notably, we identified specific cognitive and physical clinical phenotypes. These findings are important for future targeted diagnosis and treatment.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medical Psychology, Amsterdam UMC, Location AMC, Amsterdam, Netherlands",
    "GGz inGeest Specialized Mental Health Care, Amsterdam, Netherlands",
    "Department of Psychiatry, Amsterdam UMC Location VUmc, Amsterdam, Netherlands",
    "Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam, Netherlands",
    "Amsterdam Public Health, Amsterdam, Netherlands",
    "Department of Radiology & Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands",
    "Department of Radiology and Nuclear Medicine, Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, Netherlands",
    "Center for Experimental and Molecular Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands",
    "Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands",
    "Department of Intensive Care, Amsterdam UMC Location AMC, Amsterdam, Netherlands",
    "Health, Medical and Neuropsychology Unit, Institute of Psychology Leiden University, Leiden, Netherlands",
    "Department of Medical Microbiology & Infection Prevention, Amsterdam UMC Location AMC, Amsterdam, Netherlands",
    "Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands",
    "Department of Occupational Health, Human Resources, University Medical Center, Utrecht, Netherlands",
    "Department of Infectious Diseases, Amsterdam UMC Location AMC, Amsterdam, Netherlands",
    "Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, Netherlands",
    "Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, Netherlands",
    "Department of Internal Medicine, Amsterdam UMC Location AMC, Amsterdam, Netherlands"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Sander C. J. Verfaillie"
    },
    {
      "affs": [
        1
      ],
      "name": "Anouk Verveen"
    },
    {
      "affs": [
        2
      ],
      "name": "Denise Visser"
    },
    {
      "affs": [
        3
      ],
      "name": "Pythia Nieuwkerk"
    },
    {
      "affs": [
        4
      ],
      "name": "Brent Appelman"
    },
    {
      "affs": [
        5
      ],
      "name": "Ronald Boellaard"
    },
    {
      "affs": [
        6
      ],
      "name": "Caroline M. van Heugten"
    },
    {
      "affs": [
        7
      ],
      "name": "Janneke Horn"
    },
    {
      "affs": [
        8
      ],
      "name": "Hanneke E. Hulst"
    },
    {
      "affs": [
        9
      ],
      "name": "Menno D. de Jong"
    },
    {
      "affs": [
        10
      ],
      "name": "Tanja A. Kuut"
    },
    {
      "affs": [
        11
      ],
      "name": "Tessa van der Maaden"
    },
    {
      "affs": [
        12
      ],
      "name": "Yvonne M. G. van Os"
    },
    {
      "affs": [
        13
      ],
      "name": "Maria Prins"
    },
    {
      "affs": [
        14
      ],
      "name": "Johanna M. A. Visser-Meily"
    },
    {
      "affs": [
        15
      ],
      "name": "Michele van Vugt"
    },
    {
      "affs": [
        16
      ],
      "name": "Cees C. van den Wijngaard"
    },
    {
      "affs": [
        17
      ],
      "name": "Bart N. M. van Berckel"
    },
    {
      "name": "Jos A. Bosch"
    },
    {
      "name": "Nelleke Tolboom"
    },
    {
      "name": "Hans Knoop"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7tg7qwpg0ehcy.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0359844",
  "fulltext_url": null,
  "id": "7tg7qwpg0ehcy",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0359844",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2728|Long-Term Effects of COVID-19"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2"
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      "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/COVID 19"
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  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0359844&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-15",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/7tg7qwpg0ehcy.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:23Z",
      "native_id": "10.1371/journal.pone.0359844",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0359844"
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  "subjects": [
    {
      "field": "biology",
      "origin": "plos:cognitive neuroscience",
      "subfield": "neuroscience"
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    {
      "field": "mathematics",
      "origin": "plos:statistical methods",
      "subfield": "statistics"
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  ],
  "title": "Post-acute sequelae of COVID-19 (PASC) are associated with distinct clinical phenotypes two years after SARS-CoV-2 infection: A data-driven approach",
  "title_text": "Post-acute sequelae of COVID-19 (PASC) are associated with distinct clinical phenotypes two years after SARS-CoV-2 infection: A data-driven approach",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:23Z",
  "url": "https://research.draconitic.com/paper/7tg7qwpg0ehcy",
  "venue": "PLOS One",
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