Research abstract:

Chronic fatigue syndrome (CFS/ME) symptom-based phenotypes and 1-year treatment outcomes in two clinical cohorts of adult patients in the UK and The Netherlands, by  Simon M. Collin, Jon Heron, Stephanie Nikolaus, Hans Knoop, Esther Crawley in Journal of Psychosomatic Research Vol. 104, pp 29-34, January 2018


  • we previously described symptom based CFS/ME phenotypes in UK and Dutch patients.
  • These phenotypes were replicated in the new UK patient cohort.
  • Patients with multiple symptoms or pain or less likely to respond to treatment.
  • The same phenotypes and associations were observed in UK and Dutch patients.
  • The associations were robust to adjustment for severity of illness.

We previously described symptom-based chronic fatigue syndrome (CFS/ME) phenotypes in clinical assessment data from 7041 UK and 1392 Dutch adult CFS/ME patients. Here we aim to replicate these phenotypes in a more recent UK patient cohort, and investigate whether phenotypes are associated with 1-year treatment outcome.

12 specialist CFS/ME services (11 UK, 1 NL) recorded the presence/absence of 5 symptoms (muscle pain, joint pain, headache, sore throat, and painful lymph nodes) which can occur in addition to the 3 symptoms (post-exertional malaise, cognitive dysfunction, and
disturbed/unrefreshing sleep) that are present for almost all patients. Latent Class Analysis (LCA) was used to assign symptom profiles (phenotypes). Multinomial logistic regression models were fitted to quantify associations between phenotypes and overall change in health 1 year after the start of treatment.

Baseline data were available for N=918 UK and N=1392 Dutch patients, of whom 416 (45.3%) and 912 (65.5%) had 1-year follow-up data, respectively. 3- and 4-class phenotypes identified in the previous UK patient cohort were replicated in the new UK cohort. UK patients who presented with ‘polysymptomatic’ and ‘pain-only’ phenotypes were 57% and 67% less likely (multinomial odds ratio (MOR) 0.43 (95% CI 0.19-0.94)
and 0.33 (95% CI 0.13-0.84)) to report that their health was ‘very much better’ or ‘much better’ than patients who presented with an ‘oligosymptomatic’ phenotype. For Dutch patients, polysymptomatic and pain-only phenotypes were associated with 72% and 55% lower odds of improvement (MOR 0.28 (95% CI 0.11, 0.69) and 0.45 (95% CI 0.21, 0.99))
compared with oligosymptomatic patients.

Adult CFS/ME patients with multiple symptoms or pain symptoms who present for specialist treatment are much less likely to report favourable treatment outcomes than patients who present with few symptoms.

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