Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study.
Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study.
复制标题
DOI：
10.1016/s2213-2600(22)00127-8
复制
发表时间：
2022-08
影响因子：
76.2
通讯作者：
Brightling, Christopher E.
中科院分区：
文献类型：
--
作者：
Evans, Rachael A.;Leavy, Olivia C.;Richardson, Matthew;Elneima, Omer;McAuley, Hamish J. C.;Shikotra, Aarti;Singapuri, Amisha;Sereno, Marco;Saunders, Ruth M.;Harris, Victoria C.;Aul, Raminder;Beirne, Paul;Bolton, Charlotte E.;Brown, Jeremy S.;Choudhury, Gourab;Bakerly, Nawar Diar;Easom, Nicholas;Echevarria, Carlos;Fuld, Jonathan;Hart, Nick;Hurst, John R.;Jones, Mark;Parekh, Dhruv;Pfeffer, Paul;Rahman, Najib M.;Rowland-Jones, Sarah;Shah, Ajay M.;Wootton, Dan G.;Chalder, Trudie;Davies, Melanie J.;De Soyza, Anthony;Greenhalf, William;Greening, Neil J.;Heaney, Liam G.;Heller, Simon;Howard, Luke;Jacob, Joseph;Jenkins, R. Gisli;Lord, Janet M.;Man, Will D-C;McCann, Gerry P.;Neubauer, Stefan;Openshaw, Peter J. M.;Porter, Joanna;Quint, Jennifer;Rowland, Matthew J.;Scott, Janet T.;Semple, Malcolm G.;Singh, Sally J.;Toshner, Mark;Lewis, Keir;Briggs, Andrew;Docherty, Annemarie B.;Kerr, Steven;Lone, Nazir, I;Sheikh, Aziz;Thorpe, Mathew;Zheng, Bang;Chalmers, James D.;Ho, Ling-Pei;Horsley, Alex;Marks, Michael;Poinasamy, Krisnah;Raman, Betty;Harrison, Ewen M.;Wain, Louise, V;Brightling, Christopher E.
长期COVID患者尚无有效的药理学或非药理学干预措施。我们的目标是描述新冠肺炎患者出院后1年的恢复情况，确定与患者感知的恢复相关的因素，并通过描述先前描述的出院后5个月恢复组的潜在炎症情况，确定潜在的治疗靶点。新冠肺炎入院后研究是一项前瞻性的纵向队列研究，招募了英国各地与新冠肺炎一起出院的成年人(年龄18岁)。在出院后5个月和1年，使用患者报告的结果测量、体能表现和器官功能来评估恢复情况，并按患者感知的恢复和恢复分组进行分层。采用分层Logistic回归模型对1年后患者感觉恢复情况进行分析。使用大型应用k-medoid方法对5个月后的临床结果进行聚类分析。在5个月的访问中对血浆中的炎性蛋白进行分析。这项研究在ISRCTN注册处注册，ISRCTN10980107，招募工作正在进行中。在2020年3月7日至2021年4月18日期间出院的2320名参与者在出院后5个月进行评估，807名参与者(32.7%)完成了为期5个月和1年的访问。其中女性2 79例(35·6%)，男性5 0 5例(4%)，平均年龄58·7(SD12·5)岁，接受有创机械通气(WHO分级7~9级)2 2 4例(2 7 8%)。报告完全康复的患者比例在5个月(1965年的501例[25.5%])到1年(804例的232例[28.9%])之间没有变化。女性(优势比0·68[95%CI 0·46~0·99])、肥胖(0·50[0·34~0·74])和有创机械通气(0·42[0·23~0·76])与1年后不太可能完全恢复的相关因素有关。聚类分析(n=1636)证实了先前报道的四个分类：非常严重、严重、中度伴有认知损害，以及轻度，与5个月后身体健康、心理健康和认知损害的严重程度有关。我们发现，与轻度认知障碍组相比，极重度和中度认知障碍组的组织损伤和修复的炎性介质均增加，包括IL-6浓度，在两组比较(n=626名参与者)中均有所增加。我们发现，EQ-5D-5L效用指数的中位数在新冠肺炎治疗前(回顾评估；0.88[IQR 0·74-1·00])、5个月(0·74[0·-0·88])到1年(0·75[0·62-0·88])有显著的不足，整个队列和四个组中每一个组在出院后1年的所有结果指标的改善都很小。因新冠肺炎入院的患者在出院一年后在一系列健康领域有实质性的后遗症，我们队列中的少数人感觉完全康复了。患者自感健康相关生活质量在入院1年时较入院前降低。系统性炎症和肥胖是潜在的可治疗特征，值得在临床试验中进一步研究。英国研究与创新和国家健康研究所。
No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7–9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46–0·99]), obesity (0·50 [0·34–0·74]) and invasive mechanical ventilation (0·42 [0·23–0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74–1·00]), at 5 months (0·74 [0·64–0·88]) to 1 year (0·75 [0·62–0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. UK Research and Innovation and National Institute for Health Research.