Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study.
Physical, cognitive, and mental health impacts of COVID-19 after hospitalisation (PHOSP-COVID): a UK multicentre, prospective cohort study.
复制标题
DOI：
10.1016/s2213-2600(21)00383-0
复制
发表时间：
2021-11
期刊：
影响因子：
--
通讯作者：
PHOSP-COVID Collaborative Group
中科院分区：
文献类型：
--
作者：
Evans RA;McAuley H;Harrison EM;Shikotra A;Singapuri A;Sereno M;Elneima O;Docherty AB;Lone NI;Leavy OC;Daines L;Baillie JK;Brown JS;Chalder T;De Soyza A;Diar Bakerly N;Easom N;Geddes JR;Greening NJ;Hart N;Heaney LG;Heller S;Howard L;Hurst JR;Jacob J;Jenkins RG;Jolley C;Kerr S;Kon OM;Lewis K;Lord JM;McCann GP;Neubauer S;Openshaw PJM;Parekh D;Pfeffer P;Rahman NM;Raman B;Richardson M;Rowland M;Semple MG;Shah AM;Singh SJ;Sheikh A;Thomas D;Toshner M;Chalmers JD;Ho LP;Horsley A;Marks M;Poinasamy K;Wain LV;Brightling CE;PHOSP-COVID Collaborative Group
新冠肺炎对因急性疾病住院后的身心健康和就业的影响尚不清楚。这项研究的目的是确定新冠肺炎相关住院对健康和就业的影响，确定与康复相关的因素，并描述康复表型。入院后新冠肺炎研究(PHOSP-COVID)是一项多中心的长期跟踪研究，对象是英国临床诊断为新冠肺炎的出院成年人(年龄18岁)，涉及出院后2至7个月的评估，包括详细的症状记录和生理生化测试。以年龄、性别、种族、体重指数、合并症和急性疾病的严重程度为协变量，对患者感知康复的主要结果进行多变量Logistic回归。对呼吸困难、疲劳、心理健康、认知障碍和身体表现的结果进行了特别后聚类分析，方法是对大型应用程序k-medoid进行群集化。该研究已在ISRCTN注册中心注册(ISRCTN10980107)。我们报告了在2020年3月5日至11月30日期间出院的1077名患者的研究结果，他们在出院后接受了中位数为5.9个月(IQR 4.9-6.5)的评估。参与者的平均年龄为58岁(SD 13)；384名(36%)为女性，710名(69%)为白人，288名(27%)接受过机械通气，540名(50%)至少有两种合并症。在随访时，830名参与者中只有239名(29%)感觉完全康复，806名参与者中有158名(20%)有新的残疾(由华盛顿小组功能短片评估)，641名参与者中有124名(19%)经历了与健康有关的职业变化。未痊愈的相关因素包括女性、中年(40-59岁)、两个或两个以上的合并症以及较严重的急性疾病。持续的健康负担是巨大的，但与急性疾病的严重程度只有微弱的联系。有四组患者具有不同程度的心理和身体健康损害(n=767)：极重度(131例，17%)、重度(159例，21%)、中度伴认知损害(127例，17%)和轻度(350例，46%)。在聚类分析中使用的结果中，除认知障碍外，所有结果都密切相关。极重度组113名患者中有3名(3%)，重度组129名患者中有9名(7%)，中度组99名患者中有36名(36%)，轻度组267名患者中有114名(43%)感觉完全康复。持续升高的血清C-反应蛋白与集群严重程度呈正相关。我们确定了与出院后6个月新冠肺炎入院后未恢复的相关因素(例如，女性、中年、两个或两个以上合并症、较急性重症)和四种不同的恢复表型。身体和精神健康损害的严重程度密切相关，而认知健康损害是独立的。在临床护理方面，需要跨急性严重程度采取积极主动的方法，进行跨学科合作，广泛获得新冠肺炎整体临床服务，并有可能进行分层护理。英国研究与创新和国家健康研究所。
The impact of COVID-19 on physical and mental health and employment after hospitalisation with acute disease is not well understood. The aim of this study was to determine the effects of COVID-19-related hospitalisation on health and employment, to identify factors associated with recovery, and to describe recovery phenotypes. The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a multicentre, long-term follow-up study of adults (aged ≥18 years) discharged from hospital in the UK with a clinical diagnosis of COVID-19, involving an assessment between 2 and 7 months after discharge, including detailed recording of symptoms, and physiological and biochemical testing. Multivariable logistic regression was done for the primary outcome of patient-perceived recovery, with age, sex, ethnicity, body-mass index, comorbidities, and severity of acute illness as covariates. A post-hoc cluster analysis of outcomes for breathlessness, fatigue, mental health, cognitive impairment, and physical performance was done using the clustering large applications k-medoids approach. The study is registered on the ISRCTN Registry (ISRCTN10980107). We report findings for 1077 patients discharged from hospital between March 5 and Nov 30, 2020, who underwent assessment at a median of 5·9 months (IQR 4·9–6·5) after discharge. Participants had a mean age of 58 years (SD 13); 384 (36%) were female, 710 (69%) were of white ethnicity, 288 (27%) had received mechanical ventilation, and 540 (50%) had at least two comorbidities. At follow-up, only 239 (29%) of 830 participants felt fully recovered, 158 (20%) of 806 had a new disability (assessed by the Washington Group Short Set on Functioning), and 124 (19%) of 641 experienced a health-related change in occupation. Factors associated with not recovering were female sex, middle age (40–59 years), two or more comorbidities, and more severe acute illness. The magnitude of the persistent health burden was substantial but only weakly associated with the severity of acute illness. Four clusters were identified with different severities of mental and physical health impairment (n=767): very severe (131 patients, 17%), severe (159, 21%), moderate along with cognitive impairment (127, 17%), and mild (350, 46%). Of the outcomes used in the cluster analysis, all were closely related except for cognitive impairment. Three (3%) of 113 patients in the very severe cluster, nine (7%) of 129 in the severe cluster, 36 (36%) of 99 in the moderate cluster, and 114 (43%) of 267 in the mild cluster reported feeling fully recovered. Persistently elevated serum C-reactive protein was positively associated with cluster severity. We identified factors related to not recovering after hospital admission with COVID-19 at 6 months after discharge (eg, female sex, middle age, two or more comorbidities, and more acute severe illness), and four different recovery phenotypes. The severity of physical and mental health impairments were closely related, whereas cognitive health impairments were independent. In clinical care, a proactive approach is needed across the acute severity spectrum, with interdisciplinary working, wide access to COVID-19 holistic clinical services, and the potential to stratify care. UK Research and Innovation and National Institute for Health Research.