Are current CFS criteria diagnosing different disease phenotypes? (2017) MacLachlan, Newton et al

Cheshire · Oct 21, 2017

Are current chronic fatigue syndrome criteria diagnosing different disease phenotypes?
Laura Maclachlan, Stuart Watson, Peter Gallagher, Andreas Finkelmeyer, Leonard A. Jason, Madison Sunnquist, Julia L. Newton
Plos One - oct 2017

Importance
Chronic fatigue syndrome (CFS) is characterised by a constellation of symptoms diagnosed with a number of different polythetic criteria. Heterogeneity across these diagnostic criteria is likely to be confounding research into the as-yet-unknown pathophysiology underlying this stigmatised and debilitating condition and may diagnose a disease spectrum with significant implications for clinical management. No studies to date have objectively investigated this possibility using a validated measure of CFS symptoms–the DePaul Symptom Questionnaire (DSQ).

Objective
To examine whether current CFS diagnostic criteria are identifying different disease phenotypes using the DSQ.

Design
Case control study.

Setting
Clinical Research Facility of the Royal Victoria Infirmary, Newcastle upon Tyne, UK.

Participants
49 CFS subjects and ten matched, sedentary community controls, excluded for co-morbid depression.

Main outcomes and measures
Self-reported autonomic and cognitive features were assessed with the Composite Autonomic Symptom Score (COMPASS) and Cognitive Failures Questionnaire (COGFAIL) respectively. Objective autonomic cardiovascular parameters were examined using the Task Force® Monitor and a battery of neuropsychological tests administered for objective cognitive assessment.

Results
Self-reported autonomic and cognitive symptoms were significantly greater in CFS subjects compared to controls. There were no statistically significant differences in objective autonomic measures between CFS and controls. There were clinically significant differences between DSQ subgroups on objective autonomic testing. Visuospatial memory, verbal memory and psychomotor speed were significantly different between DSQ subgroups.

Conclusions and relevance
The finding of no significant differences in objective autonomic testing between CFS and control subjects may reflect the inclusion of sedentary controls or exclusion for co-morbid depression. Consistent exclusion criteria would enable better delineation of these two conditions and their presenting symptoms. Findings across CFS subgroups suggest subjects have a different disease burden on subjective and objective measures of function, autonomic parameters and cognitive impairment when categorised using the DSQ. Different CFS criteria may at best be diagnosing a spectrum of disease severities and at worst different CFS phenotypes or even different diseases. This complicates research and disease management and may contribute to the significant stigma associated with the condition.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186885

Sean · Oct 21, 2017

No 2-day test format?

Andy · Oct 21, 2017

My random thoughts. Lennie churns a lot of these things out doesn't he? I don't understand why, given that there are only 49 patients, they only used 10 controls. And this was funded by the MRC.

Dolphin · Oct 29, 2017

Free full text: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186885

Dolphin · Oct 21, 2017

This has a handy individual patient data file for anyone interested:
https://doi.org/10.1371/journal.pone.0186885.s001

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Are current CFS criteria diagnosing different disease phenotypes? (2017) MacLachlan, Newton et al

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Are current CFS criteria diagnosing different disease phenotypes? (2017) MacLachlan, Newton et al

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