Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study.
Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study.
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DOI：
10.1371/journal.pone.0239570
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发表时间：
2020
期刊：
影响因子：
3.7
通讯作者：
Rovere-Querini P
中科院分区：
文献类型：
--
作者：
De Lorenzo R;Conte C;Lanzani C;Benedetti F;Roveri L;Mazza MG;Brioni E;Giacalone G;Canti V;Sofia V;D'Amico M;Di Napoli D;Ambrosio A;Scarpellini P;Castagna A;Landoni G;Zangrillo A;Bosi E;Tresoldi M;Ciceri F;Rovere-Querini P
缺乏2019冠状病毒病（COVID-19）后剩余临床损伤的数据。本研究的目的是调查COVID-19是否留下残余功能障碍，并确定可能受益于出院后监测的患者。所有年龄≥18岁因COVID-19而入住急诊科（艾德）并在2020年4月7日至5月7日期间进行出院后随访评估的患者均入选。主要结局是需要随访，定义为随访时至少存在以下情况之一：呼吸频率（RR）>20次/min，需要治疗改变的血压（BP）不受控制，中度至极重度呼吸困难，营养不良或新发认知障碍，根据验证评分。创伤后应激障碍（PTSD）作为次要结局。共纳入185例患者。从出院到随访的中位[四分位距]时间为23天。109例（58.9%）患者需要随访。在随访评估时，58例（31.3%）患者呼吸困难，41例（22.2%）呼吸急促，10例（5.4%）营养不良，106例（57.3%）存在营养不良风险。40例（21.6%）患者血压不受控制，需要改变治疗，47例（25.4%）新发认知功能障碍。41例（22.2%）患者出现PTSD。在回归树分析中，动脉氧分压与吸入氧分数的比值（PaO 2/FiO 2）、艾德就诊时的体重指数（BMI）和年龄是随访需求的独立预测因素。PaO 2/FiO 2 <324和BMI ≥33 Kg/m2的患者需要随访的几率最高。在住院患者中，年龄≥63岁或年龄<63岁+无创通气或糖尿病的患者最有可能需要随访。PTSD是由女性性别和住院独立预测的，后者具有保护作用（比值比，OR，4.03，95%置信区间，CI，1.76 - 9.47，p 0.0011; OR 0.37，95% CI 0.14 - 0.92，p 0.033）。COVID-19留下了身体和心理功能障碍。应针对选定的患者实施后续方案。
Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. All patients aged ≥18 years admitted to the Emergency Department (ED) for COVID-19, and evaluated at post-discharge follow-up between 7 April and 7 May, 2020, were enrolled. Primary outcome was need of follow-up, defined as the presence at follow-up of at least one among: respiratory rate (RR) >20 breaths/min, uncontrolled blood pressure (BP) requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Post-traumatic stress disorder (PTSD) served as secondary outcome. 185 patients were included. Median [interquartile range] time from hospital discharge to follow-up was 23 days. 109 (58.9%) patients needed follow-up. At follow-up evaluation, 58 (31.3%) patients were dyspnoeic, 41 (22.2%) tachypnoeic, 10 (5.4%) malnourished, 106 (57.3%) at risk for malnutrition. Forty (21.6%) patients had uncontrolled BP requiring therapeutic change, and 47 (25.4%) new-onset cognitive impairment. PTSD was observed in 41 (22.2%) patients. At regression tree analysis, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and body mass index (BMI) at ED presentation, and age emerged as independent predictors of the need of follow-up. Patients with PaO2/FiO2 <324 and BMI ≥33 Kg/m2 had the highest odds to require follow-up. Among hospitalised patients, age ≥63 years, or age <63 plus non-invasive ventilation or diabetes identified those with the highest probability to need follow-up. PTSD was independently predicted by female gender and hospitalisation, the latter being protective (odds ratio, OR, 4.03, 95% confidence interval, CI, 1.76 to 9.47, p 0.0011; OR 0.37, 95% CI 0.14 to 0.92, p 0.033, respectively). COVID-19 leaves behind physical and psychological dysfunctions. Follow-up programmes should be implemented for selected patients.
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