1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study.
1-year outcomes in hospital survivors with COVID-19: a longitudinal cohort study.
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DOI：
10.1016/s0140-6736(21)01755-4
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发表时间：
2021-08-28
期刊：
影响因子：
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通讯作者：
Cao B
中科院分区：
文献类型：
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作者：
Huang L;Yao Q;Gu X;Wang Q;Ren L;Wang Y;Hu P;Guo L;Liu M;Xu J;Zhang X;Qu Y;Fan Y;Li X;Li C;Yu T;Xia J;Wei M;Chen L;Li Y;Xiao F;Liu D;Wang J;Wang X;Cao B
新冠肺炎对出院患者的长期健康后果在很大程度上尚不清楚。我们研究的目的是全面比较新冠肺炎患者在住院期间出现症状的6个月和12个月的后果。我们对2020年1月7日至5月29日从金银滩医院(武汉，中国)出院的新冠肺炎幸存者进行了双向队列研究。在6个月和12个月的随访中，对幸存者进行症状和健康相关生活质量(HRQOL)问卷调查，并进行体检、6分钟步行试验和实验室检查。他们被要求在12个月的访问中报告他们出院后的医疗保健使用情况和工作状况。在6个月时完成肺功能检查或有肺X线异常的幸存者在12个月时进行相应的检查。年龄、性别和合并症匹配的非新冠肺炎参与者(对照组)被采访并完成问卷，以评估普遍症状和高分辨生活质量。主要结果是症状、改良的英国医学研究理事会(MMRC)评分、HRQOL和6min内的步行距离(6MWD)。采用多变量调整后的Logistic回归模型评估12个月预后的危险因素。1,276名新冠肺炎幸存者完成了这两次访问。患者平均年龄59.0岁(IQR49.0~67.0)，男性681例(53%)。症状出现后6个月的中位随访期为185·0天(IQR 175·0~198·0)，12个月的中位随访期为349·0天(337·0~361·0)。至少有一种后遗症的患者比例从6个月的68%(831/1227)下降到12个月的49%(620/1272)(p<；0.0001)。以MMRC评分1或以上为特征的呼吸困难患者的比例从6个月时的26%(313/1185)略微增加到12个月时的30%(380/1271)(p=0.014)。此外，12个月随访时出现焦虑或抑郁的患者较多(12个月时为26%[331/1271]，6个月时为23%[274/1187]；p=0.015)。6个月与12个月的6MWD差异无统计学意义。88%(422/479)在新冠肺炎前就业的患者在12个月后回到了原来的工作岗位。与男性相比，女性疲劳或肌肉无力的优势比为1·43(95%CI 1·04~1·96)，焦虑或抑郁的优势比为2·00(1·48~2·69)，扩散障碍的优势比为2·97(1·50~5·88)。与对照组相比，配对后12个月的新冠肺炎幸存者在行动不便、疼痛或不适以及焦虑或抑郁方面有更多问题，并且有更普遍的症状。大多数新冠肺炎幸存者在1年的随访中身体和功能恢复良好，并已恢复到原来的工作和生活。我们的新冠肺炎幸存者队列中12个月时的健康状况仍然低于对照人群。中国医学科学院医学科学创新基金、中国国家自然科学基金、中国国家重点研究发展计划、结核病新药研发国家科技重大专项、中国恒大集团、马云基金会、中国生物医药、平安保险(集团)、新阳光慈善基金会。
The full range of long-term health consequences of COVID-19 in patients who are discharged from hospital is largely unclear. The aim of our study was to comprehensively compare consequences between 6 months and 12 months after symptom onset among hospital survivors with COVID-19. We undertook an ambidirectional cohort study of COVID-19 survivors who had been discharged from Jin Yin-tan Hospital (Wuhan, China) between Jan 7 and May 29, 2020. At 6-month and 12-month follow-up visit, survivors were interviewed with questionnaires on symptoms and health-related quality of life (HRQoL), and received a physical examination, a 6-min walking test, and laboratory tests. They were required to report their health-care use after discharge and work status at the 12-month visit. Survivors who had completed pulmonary function tests or had lung radiographic abnormality at 6 months were given the corresponding tests at 12 months. Non-COVID-19 participants (controls) matched for age, sex, and comorbidities were interviewed and completed questionnaires to assess prevalent symptoms and HRQoL. The primary outcomes were symptoms, modified British Medical Research Council (mMRC) score, HRQoL, and distance walked in 6 min (6MWD). Multivariable adjusted logistic regression models were used to evaluate the risk factors of 12-month outcomes. 1276 COVID-19 survivors completed both visits. The median age of patients was 59·0 years (IQR 49·0–67·0) and 681 (53%) were men. The median follow-up time was 185·0 days (IQR 175·0–198·0) for the 6-month visit and 349·0 days (337·0–361·0) for the 12-month visit after symptom onset. The proportion of patients with at least one sequelae symptom decreased from 68% (831/1227) at 6 months to 49% (620/1272) at 12 months (p<0·0001). The proportion of patients with dyspnoea, characterised by mMRC score of 1 or more, slightly increased from 26% (313/1185) at 6-month visit to 30% (380/1271) at 12-month visit (p=0·014). Additionally, more patients had anxiety or depression at 12-month visit (26% [331/1271] at 12-month visit vs 23% [274/1187] at 6-month visit; p=0·015). No significant difference on 6MWD was observed between 6 months and 12 months. 88% (422/479) of patients who were employed before COVID-19 had returned to their original work at 12 months. Compared with men, women had an odds ratio of 1·43 (95% CI 1·04–1·96) for fatigue or muscle weakness, 2·00 (1·48–2·69) for anxiety or depression, and 2·97 (1·50–5·88) for diffusion impairment. Matched COVID-19 survivors at 12 months had more problems with mobility, pain or discomfort, and anxiety or depression, and had more prevalent symptoms than did controls. Most COVID-19 survivors had a good physical and functional recovery during 1-year follow-up, and had returned to their original work and life. The health status in our cohort of COVID-19 survivors at 12 months was still lower than that in the control population. Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences, the National Natural Science Foundation of China, the National Key Research and Development Program of China, Major Projects of National Science and Technology on New Drug Creation and Development of Pulmonary Tuberculosis, the China Evergrande Group, Jack Ma Foundation, Sino Biopharmaceutical, Ping An Insurance (Group), and New Sunshine Charity Foundation.