Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study.
Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study.
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DOI：
10.1164/rccm.202203-0564oc
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发表时间：
2023-03-15
影响因子：
24.7
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中科院分区：
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冠状病毒病（COVID-19）和肺纤维化之间的共同症状和遗传结构表明，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染可能导致进行性肺损伤。英国间质性肺病联盟（UKILD）COVID-19研究后中期分析计划根据风险分层估计因COVID-19住院的患者中残留肺部异常的患病率。PHOSP-COVID-19（住院后COVID-19）研究用于收集出院后240天内的常规和研究随访。对与PHOSP-COVID-19标识符相关的胸部计算机断层扫描的残留肺部异常（磨玻璃影和网状影）百分比进行评分。用贝叶斯二项回归估计关联计算机断层扫描的风险因素，并生成风险分层。使用贝叶斯二项分布，使用分层内的数字估计住院后患病率。敏感性分析仅限于方案驱动的研究随访的参与者。临时队列包括3，700人。在209名进行相关计算机断层扫描的受试者中（中位数，119天;四分位数范围，83-155），166人（79.4%）有超过10%的残留肺异常。危险因素包括胸部X线检查异常（危险比[RR]，1.21; 95%可信区间[CrI]，1.05-1.40）、预测DlCO百分比小于80%（RR，1.25; 95% CrI，1.00-1.56）和需要通气支持的严重入院（RR，1.27; 95% CrI，1.07-1.55）。在剩下的3,491人中，残留肺异常的中度至极高风险被分类为7.8%，估计住院后患病率为8.5%（95%CrI，7.6-9.5），在敏感性分析中上升至11.7%（95%CrI，10.3-13.1）。在COVID-19相关住院治疗后出院的患者中，估计有高达11%的人存在残余肺部异常。卫生服务部门应监测高危人群，以阐明长期功能影响。
Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage. The UK Interstitial Lung Disease Consortium (UKILD) post–COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata. The PHOSP–COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP–COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up. The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83–155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05–1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00–1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07–1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6–9.5), rising to 11.7% (95% CrI, 10.3–13.1) in the sensitivity analysis. Residual lung abnormalities were estimated in up to 11% of people discharged after COVID-19–related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications.