Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people
Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people
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DOI：
10.1101/2021.06.28.21259452
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
M. Whitaker;J. Elliott;M. Chadeau-Hyam;S. Riley;A. Darzi;G. Cooke;H. Ward;P. Elliott
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文献类型：
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作者：
M. Whitaker;J. Elliott;M. Chadeau-Hyam;S. Riley;A. Darzi;G. Cooke;H. Ward;P. Elliott
长期COVID描述了SARS-CoV-2感染后的长期后遗症，仍然是一种定义不清的综合征。其诱发因素和由此产生的公共卫生负担程度尚不确定，对流行率和持续时间的估计差异很大。方法在REACT-2研究的第3-5轮中，英格兰社区的508，707人被问及COVID-19既往史以及29种不同症状的存在和持续时间。我们使用单变量和多变量模型来确定症状持续性（12周或更长时间）的预测因素。我们估计了12周时症状持续性的患病率，并使用无监督学习来根据经历的症状对个体进行聚类。结果在508，707名参与者中，自报COVID-19的加权患病率为19.2%（95%CI：19.1，19.3）。在76，155名COVID-19后有症状的人中，37.7%的人至少经历了一种症状，而14.8%的人经历了三种或三种以上症状，持续12周或更长时间。这给出了一种持续症状的加权人群患病率为5.75%（5.68，5.81），三种或三种以上症状的加权人群患病率为2.22%（2.1，2.26）。在至少有一种症状持续12周或更长时间的8，771/28，713人（30.5%）中，近三分之一的人报告在患病时有严重的COVID-19症状（“对我的日常生活产生重大影响”），这一群体的加权患病率为1.72%（1.69，1.76）。女性中持续症状的患病率高于男性（OR：1.51 [1.46，1.55]），在报告症状的条件下，持续症状的风险随年龄线性增加，每十年增加3.5个百分点。肥胖、吸烟或吸电子烟、住院和剥夺也与持续症状的概率较高相关，而亚洲种族与概率较低相关。根据持续12周或更长时间的症状确定了两个稳定的集群：在最大的集群中，疲劳占主导地位，而在第二个集群中，呼吸系统和相关症状的患病率很高。解释相当一部分有症状的COVID-19患者会持续出现12周或更长时间的持续症状，这取决于年龄。临床医生需要了解长期COVID的不同表现，这可能需要量身定制的治疗方法。在下一阶段的大流行中，管理SARS-CoV-2感染在人群中的长期后遗症仍将是卫生服务的主要挑战。
Introduction Long COVID, describing the long-term sequelae after SARS-CoV-2 infection, remains a poorly defined syndrome. There is uncertainty about its predisposing factors and the extent of the resultant public health burden, with estimates of prevalence and duration varying widely. Methods Within rounds 3-5 of the REACT-2 study, 508,707 people in the community in England were asked about a prior history of COVID-19 and the presence and duration of 29 different symptoms. We used uni- and multivariable models to identify predictors of persistence of symptoms (12 weeks or more). We estimated the prevalence of symptom persistence at 12 weeks, and used unsupervised learning to cluster individuals by symptoms experienced. Results Among the 508,707 participants, the weighted prevalence of self-reported COVID-19 was 19.2% (95% CI: 19.1,19.3). 37.7% of 76,155 symptomatic people post COVID-19 experienced at least one symptom, while 14.8% experienced three or more symptoms, lasting 12 weeks or more. This gives a weighted population prevalence of persistent symptoms of 5.75% (5.68, 5.81) for one and 2.22% (2.1, 2.26) for three or more symptoms. Almost a third of people 8,771/28,713 (30.5%) with at least one symptom lasting 12 weeks or more reported having had severe COVID-19 symptoms ('significant effect on my daily life') at the time of their illness, giving a weighted prevalence overall for this group of 1.72% (1.69,1.76). The prevalence of persistent symptoms was higher in women than men (OR: 1.51 [1.46,1.55]) and, conditional on reporting symptoms, risk of persistent symptoms increased linearly with age by 3.5 percentage points per decade of life. Obesity, smoking or vaping, hospitalisation , and deprivation were also associated with a higher probability of persistent symptoms, while Asian ethnicity was associated with a lower probability. Two stable clusters were identified based on symptoms that persisted for 12 weeks or more: in the largest cluster, tiredness predominated, while in the second there was a high prevalence of respiratory and related symptoms. Interpretation A substantial proportion of people with symptomatic COVID-19 go on to have persistent symptoms for 12 weeks or more, which is age-dependent. Clinicians need to be aware of the differing manifestations of Long COVID which may require tailored therapeutic approaches. Managing the long-term sequelae of SARS-CoV-2 infection in the population will remain a major challenge for health services in the next stage of the pandemic.