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. 2021 Sep 29;9(10):1290.
doi: 10.3390/healthcare9101290.

A Comprehensive Examination of Severely Ill ME/CFS Patients

Chia-Jung Chang  1   2   3 , Li-Yuan Hung  4 , Andreas M Kogelnik  5 , David Kaufman  1 , Raeka S Aiyar  1   2   3 , Angela M Chu  1   2   3 , Julie Wilhelmy  1   2   3 , Peng Li  4 , Linda Tannenbaum  6 , Wenzhong Xiao  1   2   3   4 , Ronald W Davis  1   2   3   7
Affiliations

A Comprehensive Examination of Severely Ill ME/CFS Patients

Chia-Jung Chang et al. Healthcare (Basel). .

Abstract

One in four myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients are estimated to be severely affected by the disease, and these house-bound or bedbound patients are currently understudied. Here, we report a comprehensive examination of the symptoms and clinical laboratory tests of a cohort of severely ill patients and healthy controls. The greatly reduced quality of life of the patients was negatively correlated with clinical depression. The most troublesome symptoms included fatigue (85%), pain (65%), cognitive impairment (50%), orthostatic intolerance (45%), sleep disturbance (35%), post-exertional malaise (30%), and neurosensory disturbance (30%). Sleep profiles and cognitive tests revealed distinctive impairments. Lower morning cortisol level and alterations in its diurnal rhythm were observed in the patients, and antibody and antigen measurements showed no evidence for acute infections by common viral or bacterial pathogens. These results highlight the urgent need of developing molecular diagnostic tests for ME/CFS. In addition, there was a striking similarity in symptoms between long COVID and ME/CFS, suggesting that studies on the mechanism and treatment of ME/CFS may help prevent and treat long COVID and vice versa.

Keywords: antibody and antigen; clinical symptoms; cognitive tests; laboratory tests; long COVID; post-acute sequelae SARS-CoV-2 infection (PASC); quality of life; severe ME/CFS; sleep; viral infection.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Comparison of the Quality of Life of Severely Ill myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and Other Major Diseases. (a) SF-36 scores of Severely Ill Patient Study (SIPS) patients, general CFS patients, and healthy controls. Compared with the general CFS patient population, scores on physical functioning (PF), role limitations due to physical health (RP), general health (GH), vitality/energy/fatigue (VT), and social functioning (SF) were significantly lower. (b) tSNE of SF-36 scores of SIPS, general CFS, and other medical conditions. T2D—type II diabetes, HT—hypertension, CHF—congestive heart failure, COPD—chronic obstructive pulmonary disease, MSCs—musculoskeletal complaints, BPH—benign prostatic hyperplasia, AMI—anterior myocardial infarction, and OA—Osteoarthritis. The quality-of-life scores of SIPS patients were clearly separated from that of controls, being most positively correlated with congestive heart failure (CHF) and most negatively correlated with clinical depression.
Figure 2
Figure 2
Common Symptoms in Severe ME/CFS Patients. (a) Similarity and variation of the symptoms of the SIPS patients and (b) the top three most troublesome symptoms of the SIPS Patients.
Figure 3
Figure 3
Sleep Monitoring and Cognitive Tests of the Severe ME/CFS Patients. (a) Five parameters in the overnight monitoring by Sleep Profiler where the values in ≥50% of the patients were consistently out of the normal ranges. These include lower sleep efficiency, more frequent awakenings per hour (>30 s), longer time of wake after sleep onset, a higher percentage of Stage N1, and a lower percentage of Stage R (REM). (b) Comparison between the patients and controls in each of the four sections of cognitive tests. The Y-axis represents the percentage of subjects that were identified as severe/deficit impairment. The patients compared with the controls showed significantly more problems in identifying emotions (94% of the patients vs. 40% of the controls, p = 0.005), as well as more attention problems (81% of the patients vs. 40% of the controls, p = 0.046).
Figure 4
Figure 4
Clinical Lab Test Results Significantly Different between Severe ME/CFS and Controls. (a) Results of 4-point salivary cortisol upon wakening, at noon, afternoon, and night. The severe patients demonstrated significantly lower salivary cortisol concentrations in the morning and a significant flattening of the diurnal cortisol profile. (b–d) Results of a significantly higher level of cholesterol/HDL ratio (b), lower level of albumin, (c) and lower total bilirubin, (d) in the blood of the patients than of the controls.
Figure 5
Figure 5
Comparison of the symptoms reported in the long COVID patients after 6 months with those in the severely ill ME/CFS patients. The symptoms are ranked based on the frequencies reported in the long COVID patients. The frequencies of these symptoms in the severely ill ME/CFS are similar to those reported in the long COVID.
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