D'Cruz Rebecca F, Waller Michael D, Perrin Felicity, Periselneris Jimstan, Norton Sam, Smith Laura-Jane, Patrick Tanya, Walder David, Heitmann Amadea, Lee Kai, Madula Rajiv, McNulty William, Macedo Patricia, Lyall Rebecca, Warwick Geoffrey, Galloway James B, Birring Surinder S, Patel Amit, Patel Irem, Jolley Caroline J
Centre for Human and Applied Physiological Sciences, King's College London, London, UK.
Dept of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK.
ERJ Open Res. 2021 Feb 8;7(1). doi: 10.1183/23120541.00655-2020. eCollection 2021 Jan.
A standardised approach to assessing COVID-19 survivors has not been established, largely due to the paucity of data on medium- and long-term sequelae. Interval chest radiography is recommended following community-acquired pneumonia; however, its utility in monitoring recovery from COVID-19 pneumonia remains unclear.
This was a prospective single-centre observational cohort study. Patients hospitalised with severe COVID-19 pneumonia (admission duration ≥48 h and oxygen requirement ≥40% or critical care admission) underwent face-to-face assessment at 4-6 weeks post-discharge. The primary outcome was radiological resolution of COVID-19 pneumonitis (Radiographic Assessment of Lung Oedema score <5). Secondary outcomes included clinical outcomes, symptom questionnaires, mental health screening (Trauma Screening Questionnaire, seven-item Generalised Anxiety Disorder assessment and nine-item Patient Health Questionnaire) and physiological testing (4-m gait speed (4MGS) and 1-min Sit-to-Stand (STS) tests).
119 patients were assessed between June 3, 2020 and July 2, 2020 at median (interquartile range (IQR)) 61 (51-67) days post-discharge: mean±sd age 58.7±14.4 years, median (IQR) body mass index 30.0 (25.9-35.2) kg·m, 62% male and 70% ethnic minority. Despite radiographic resolution of pulmonary infiltrates in 87%, modified Medical Research Council Dyspnoea (breathlessness) scale grades were above pre-COVID-19 baseline in 44%, and patients reported persistent fatigue (68%), sleep disturbance (57%) and breathlessness (32%). Screening thresholds were breached for post-traumatic stress disorder (25%), anxiety (22%) and depression (18%). 4MGS was slow (<0.8 m·s) in 38% and 35% desaturated by ≥4% during the STS test. Of 56 thoracic computed tomography scans performed, 75% demonstrated COVID-19-related interstitial and/or airways disease.
Persistent symptoms, adverse mental health outcomes and physiological impairment are common 2 months after severe COVID-19 pneumonia. Follow-up chest radiography is a poor marker of recovery; therefore, holistic face-to-face assessment is recommended to facilitate early recognition and management of post-COVID-19 sequelae.
评估新冠病毒病康复者的标准化方法尚未确立，这主要是由于关于中长期后遗症的数据匮乏。社区获得性肺炎后建议进行定期胸部X光检查；然而，其在监测新冠病毒病肺炎康复情况方面的作用仍不明确。
这是一项前瞻性单中心观察性队列研究。因重症新冠病毒病肺炎住院的患者（住院时长≥48小时且需氧量≥40%或入住重症监护病房）在出院后4至6周接受面对面评估。主要结局是新冠病毒病肺炎的影像学消退（肺水肿影像学评估评分<5）。次要结局包括临床结局、症状问卷、心理健康筛查（创伤筛查问卷、七项广泛性焦虑症评估和九项患者健康问卷）以及生理测试（4米步行速度（4MGS）和1分钟坐立试验（STS））。
在2020年6月3日至2020年7月2日期间，对119例患者进行了评估，出院后中位（四分位间距（IQR））时间为61（51 - 67）天：平均±标准差年龄为58.7±14.4岁，中位（IQR）体重指数为30.0（25.9 - 35.2）kg·m²，62%为男性，70%为少数族裔。尽管87%的患者肺部浸润灶影像学消退，但44%的患者改良医学研究委员会呼吸困难量表分级高于新冠病毒病前基线水平，且患者报告持续疲劳（68%）、睡眠障碍（57%）和呼吸困难（32%）。创伤后应激障碍（25%）、焦虑（22%）和抑郁（18%）的筛查阈值被突破。38%的患者4MGS较慢（<0.8m/s），35%的患者在STS试验期间血氧饱和度下降≥4%。在进行的56次胸部计算机断层扫描中，75%显示有与新冠病毒病相关的间质性和/或气道疾病。
重症新冠病毒病肺炎2个月后，持续症状、不良心理健康结局和生理功能受损很常见。随访胸部X光检查并非康复的良好指标；因此，建议进行全面的面对面评估，以便早期识别和管理新冠病毒病后遗症。
