Precision Medicine for More Oxygen (P4O2)—Study Design and First Results of the Long COVID-19 Extension
Authors: Baalbaki Nadia , Blankestijn Jelle M. , Abdel-Aziz Mahmoud I. , de Backer Jan , Bazdar Somayeh , Beekers Inés , Beijers Rosanne J. H. C. G. , van den Bergh Joop P. , Bloemsma Lizan D. , Bogaard Harm Jan , van Bragt Job J. M. H. , van den Brink Vera , Charbonnier Jean Paul , Cornelissen Merel E. B. , Dagelet Yennece , Davies Elin Haf , van der Does Anne M. , Downward George S. , van Drunen Cornelis M. , Gach Debbie , Geelhoed J. J. Miranda , Glastra Jorrit , Golebski Kornel , Heijink Irene H. , Holtjer Judith C. S. , Holverda Sebastiaan , Houweling Laura , Jacobs John J. L. , Jonker Renée , Kos Renate , Langen Ramon C. J. , van der Lee Ivo , Leliveld Asabi , Mohamed Hoesein Firdaus A. A. , Neerincx Anne H. , Noij Lieke , Olsson Johan , van de Pol Marianne , Pouwels Simon D. , Rolink Emiel , Rutgers Michael , Șahin Havva , Schaminee Daphne , Schols Annemie M. W. J. , Schuurman Lisanne , Slingers Gitte , Smeenk Olie , Sondermeijer Brigitte , Skipp Paul J. , Tamarit Marisca , Verkouter Inge , Vermeulen Roel , de Vries Rianne , Weersink Els J. M. , van de Werken Marco , de Wit-van Wijck Yolanda , Young Stewart , Nossent Esther J. , Maitland-van der Zee Anke H. 
Published: June 2023

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has led to the death of almost 7 million people, however, with a cumulative incidence of 0.76 billion, most people survive COVID-19. Several studies indicate that the acute phase of COVID-19 may be followed by persistent symptoms including fatigue, dyspnea, headache, musculoskeletal symptoms, and pulmonary functional-and radiological abnormalities. However, the impact of COVID-19 on long-term health outcomes remains to be elucidated. Aims: The Precision Medicine for more Oxygen (P4O2) consortium COVID-19 extension aims to identify long COVID patients that are at risk for developing chronic lung disease and furthermore, to identify treatable traits and innovative personalized therapeutic strategies for prevention and treatment. This study aims to describe the study design and first results of the P4O2 COVID-19 cohort. Methods: The P4O2 COVID-19 study is a prospective multicenter cohort study that includes nested personalized counseling intervention trial. Patients, aged 40–65 years, were recruited from outpatient post-COVID clinics from five hospitals in The Netherlands. During study visits at 3–6 and 12–18 months post-COVID-19, data from medical records, pulmonary function tests, chest computed tomography scans and biological samples were collected and questionnaires were administered. Furthermore, exposome data was collected at the patient’s home and state-of-the-art imaging techniques as well as multi-omics analyses will be performed on collected data. Results: 95 long COVID patients were enrolled between May 2021 and September 2022. The current study showed persistence of clinical symptoms and signs of pulmonary function test/radiological abnormalities in post-COVID patients at 3–6 months post-COVID. The most commonly reported symptoms included respiratory symptoms (78.9%), neurological symptoms (68.4%) and fatigue (67.4%). Female sex and infection with the Delta, compared with the Beta, SARS-CoV-2 variant were significantly associated with more persisting symptom categories. Conclusions: The P4O2 COVID-19 study contributes to our understanding of the long-term health impacts of COVID-19. Furthermore, P4O2 COVID-19 can lead to the identification of different phenotypes of long COVID patients, for example those that are at risk for developing chronic lung disease. Understanding the mechanisms behind the different phenotypes and identifying these patients at an early stage can help to develop and optimize prevention and treatment strategies.