AUTHOR=Yang Zhen , Xie Zhiqin , Wang Zequan , Yi Linxia , Chen Shihan , Du Yunyu , Tao Xuemei , Xie Chao , Zhou Li , Zhang Min , He Chaozhu 

TITLE=Identifying central symptom clusters and correlates among post-COVID-19 pulmonary fibrosis patients: a network analysis

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1538708

DOI=10.3389/fmed.2025.1538708

ISSN=2296-858X

ABSTRACT=BackgroundPrevious studies have analyzed symptom clusters in patients with coronavirus disease 2019 (COVID-19); however, evidence regarding the core symptom clusters and their influencing factors in patients with post-COVID-19 pulmonary fibrosis (PCPF) remains unclear, affecting the precision of symptom interventions.ObjectivesThis study aimed to identify the symptom clusters and core symptom clusters in patients with PCPF. Demographic and disease-related factors associated with these symptom clusters were also analyzed.MethodsA total of 350 patients with PCPF were recruited from China between January 2023 and April 2024. A self-reported symptom assessment scale was used for this survey. Principal component analysis was used to identify symptom clusters. Network analysis was used to describe the relationships between the symptoms and symptom clusters. Multiple linear models were used to analyze the factors affecting the total symptom severity and each symptom cluster.ResultsSix symptom clusters were identified: Upper Respiratory Tract Symptom Cluster (USC), Lower Respiratory Tract Symptom Cluster (LSC), Somatic Symptom Cluster (SSC), Muscular and Joint Symptom Cluster (MSC), Neurological and Psychological Symptom Cluster (NSC), and Digestive Symptom Cluster (DSC). Fatigue was identified as the core and bridge symptom in the symptom network, whereas the upper respiratory symptom cluster was identified as the core and bridge symptom cluster. Gender, age, educational level, smoking history, and primary caregiver were associated with the scores of the six symptom clusters.ConclusionOur study suggests that there is a need to evaluate symptom clusters for the improvement of symptom management among PCPF. Specifically, the assessment and treatment of upper respiratory and fatigue symptoms as core targets of PCPF care is critical for the development of accurate and efficient symptom management strategies.