Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19: A Systematic Review.
Assessment of the Frequency and Variety of Persistent Symptoms Among Patients With COVID-19: A Systematic Review.
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DOI：
10.1001/jamanetworkopen.2021.11417
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发表时间：
2021-05-03
影响因子：
13.8
通讯作者：
Goodman SN
中科院分区：
文献类型：
--
作者：
Nasserie T;Hittle M;Goodman SN
COVID-19感染后持续症状的频率和种类是什么？在这项对45项研究（包括9751名COVID-19受试者）进行的系统性综述中，至少出现1种持续性症状的个体比例中位数为73%;最常见的症状包括呼吸短促或呼吸困难、疲劳或疲惫以及睡眠障碍或失眠。然而，这些研究具有高度异质性，需要更长的随访时间和更标准化的设计。这项系统性审查发现，COVID-19症状通常持续到感染急性期之后，对健康相关功能和生活质量产生影响;然而，需要改进方法以可靠地量化这些风险。COVID-19感染与长期症状有关，但这些并发症的频率，种类和严重程度尚不清楚。许多已发表的评论提出了主要基于老年人死亡率的流行病控制计划，而没有考虑所有年龄段人群的长期发病率。可靠的估计，这种发病率是重要的病人护理，预后和公共卫生政策的发展。对检查COVID-19感染后持续症状的频率和种类的研究进行系统回顾。对PubMed和Web of Science进行了检索，以识别2020年1月1日至2021年3月11日发表的研究，这些研究检查了COVID-19感染后的持续症状。持续性症状定义为在诊断、症状发作或住院治疗后持续至少60天，或在急性疾病恢复或出院后持续至少30天。检索词包括COVID-19、SARS-CoV-2、冠状病毒、2019-nCoV、长期、恢复后、长途、持续、结局、症状、随访和纵向。纳入了所有英文文章，这些文章提供了来自队列研究的主要数据，这些研究报告了SARS-CoV-2感染个体中持续症状的患病率，并进行了明确定义和充分的随访。病例报告、病例系列和仅描述感染和/或住院时症状的研究被排除。一个结构化的框架被应用于评价研究质量。共识别出1974条记录;其中，筛选了1247篇文章标题和摘要。删除重复和排除后，对92篇全文文章进行了合格性评估; 47项研究被认为合格，45项报告84种临床体征或症状的研究被纳入系统综述。在9751名受试者中，5266名（54.0%）为男性; 45项研究中有30项报告的平均或中位年龄小于60岁。在16项研究中，其中大部分包括既往住院的受试者，至少出现1种持续性症状的个体比例中位数为72.5%（四分位距[IQR]，55.0%-80.0%）。最常发生的个体症状包括呼吸短促或呼吸困难（26项研究;中位频率，36.0%; IQR，27.6%-50.0%）、疲乏或疲惫（25项研究;中位频率，40.0%; IQR，31.0%-57.0%）和睡眠障碍或失眠（8项研究;中位频率，29.4%，IQR，24.4%-33.0%）。研究的设计和质量差异很大，影响到解释，往往限制了直接可比性和可合并性。主要设计差异包括患者人群、时间零点（即随访间隔的开始）的定义、随访时间长度和结局定义，包括疾病严重程度的定义。这项系统性审查发现，COVID-19症状通常持续到感染急性期之后，对健康相关功能和生活质量产生影响。目前关于症状持续性的研究是高度异质性的，未来的研究需要更长的随访时间，更高的质量和更标准化的设计来可靠地量化风险。本系统性综述使用队列研究的数据，检查既往感染COVID-19的个体中持续症状的频率、种类和严重程度。
What are the frequency and variety of persistent symptoms after COVID-19 infection? In this systematic review of 45 studies including 9751 participants with COVID-19, the median proportion of individuals who experienced at least 1 persistent symptom was 73%; symptoms occurring most frequently included shortness of breath or dyspnea, fatigue or exhaustion, and sleep disorders or insomnia. However, the studies were highly heterogeneous and needed longer follow-up and more standardized designs. This systematic review found that COVID-19 symptoms commonly persisted beyond the acute phase of infection, with implications for health-associated functioning and quality of life; however, methodological improvements are needed to reliably quantify these risks. Infection with COVID-19 has been associated with long-term symptoms, but the frequency, variety, and severity of these complications are not well understood. Many published commentaries have proposed plans for pandemic control that are primarily based on mortality rates among older individuals without considering long-term morbidity among individuals of all ages. Reliable estimates of such morbidity are important for patient care, prognosis, and development of public health policy. To conduct a systematic review of studies examining the frequency and variety of persistent symptoms after COVID-19 infection. A search of PubMed and Web of Science was conducted to identify studies published from January 1, 2020, to March 11, 2021, that examined persistent symptoms after COVID-19 infection. Persistent symptoms were defined as those persisting for at least 60 days after diagnosis, symptom onset, or hospitalization or at least 30 days after recovery from the acute illness or hospital discharge. Search terms included COVID-19, SARS-CoV-2, coronavirus, 2019-nCoV, long-term, after recovery, long-haul, persistent, outcome, symptom, follow-up, and longitudinal. All English-language articles that presented primary data from cohort studies that reported the prevalence of persistent symptoms among individuals with SARS-CoV-2 infection and that had clearly defined and sufficient follow-up were included. Case reports, case series, and studies that described symptoms only at the time of infection and/or hospitalization were excluded. A structured framework was applied to appraise study quality. A total of 1974 records were identified; of those, 1247 article titles and abstracts were screened. After removal of duplicates and exclusions, 92 full-text articles were assessed for eligibility; 47 studies were deemed eligible, and 45 studies reporting 84 clinical signs or symptoms were included in the systematic review. Of 9751 total participants, 5266 (54.0%) were male; 30 of 45 studies reported mean or median ages younger than 60 years. Among 16 studies, most of which comprised participants who were previously hospitalized, the median proportion of individuals experiencing at least 1 persistent symptom was 72.5% (interquartile range [IQR], 55.0%-80.0%). Individual symptoms occurring most frequently included shortness of breath or dyspnea (26 studies; median frequency, 36.0%; IQR, 27.6%-50.0%), fatigue or exhaustion (25 studies; median frequency, 40.0%; IQR, 31.0%-57.0%), and sleep disorders or insomnia (8 studies; median 29.4%, IQR, 24.4%-33.0%). There were wide variations in the design and quality of the studies, which had implications for interpretation and often limited direct comparability and combinability. Major design differences included patient populations, definitions of time zero (ie, the beginning of the follow-up interval), follow-up lengths, and outcome definitions, including definitions of illness severity. This systematic review found that COVID-19 symptoms commonly persisted beyond the acute phase of infection, with implications for health-associated functioning and quality of life. Current studies of symptom persistence are highly heterogeneous, and future studies need longer follow-up, improved quality, and more standardized designs to reliably quantify risks. This systematic review uses data from cohort studies to examine the frequency, variety, and severity of persistent symptoms among individuals with previous COVID-19 infection.
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影响因子：
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作者：
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通讯作者：
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影响因子：
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