Université Paris-Saclay, AP-HP, Service de Réanimation Pédiatrique et Médecine Néonatale, Hôpital de Bicêtre, Santé de l'Enfant et de l'Adolescent, Le Kremlin-Bicêtre, France.
Université Paris-Saclay, AP-HP, Service de Pneumologie et Soins Intensifs Respiratoires, DMU 5, Thorinno, Inserm UMR_S999, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
JAMA. 2021 Apr 20;325(15):1525-1534. doi: 10.1001/jama.2021.3331.
Little is known about long-term sequelae of COVID-19.
To describe the consequences at 4 months in patients hospitalized for COVID-19.
DESIGN, SETTING, AND PARTICIPANTS: In a prospective uncontrolled cohort study, survivors of COVID-19 who had been hospitalized in a university hospital in France between March 1 and May 29, 2020, underwent a telephone assessment 4 months after discharge, between July 15 and September 18, 2020. Patients with relevant symptoms and all patients hospitalized in an intensive care unit (ICU) were invited for further assessment at an ambulatory care visit.
Survival of hospitalization for COVID-19.
Respiratory, cognitive, and functional symptoms were assessed by telephone with the Q3PC cognitive screening questionnaire and a checklist of symptoms. At the ambulatory care visit, patients underwent pulmonary function tests, lung computed tomographic scan, psychometric and cognitive tests (including the 36-Item Short-Form Health Survey and 20-item Multidimensional Fatigue Inventory), and, for patients who had been hospitalized in the ICU or reported ongoing symptoms, echocardiography.
Among 834 eligible patients, 478 were evaluated by telephone (mean age, 61 years [SD, 16 years]; 201 men, 277 women). During the telephone interview, 244 patients (51%) declared at least 1 symptom that did not exist before COVID-19: fatigue in 31%, cognitive symptoms in 21%, and new-onset dyspnea in 16%. There was further evaluation in 177 patients (37%), including 97 of 142 former ICU patients. The median 20-item Multidimensional Fatigue Inventory score (n = 130) was 4.5 (interquartile range, 3.0-5.0) for reduced motivation and 3.7 (interquartile range, 3.0-4.5) for mental fatigue (possible range, 1 [best] to 5 [worst]). The median 36-Item Short-Form Health Survey score (n = 145) was 25 (interquartile range, 25.0-75.0) for the subscale "role limited owing to physical problems" (possible range, 0 [best] to 100 [worst]). Computed tomographic lung-scan abnormalities were found in 108 of 171 patients (63%), mainly subtle ground-glass opacities. Fibrotic lesions were observed in 33 of 171 patients (19%), involving less than 25% of parenchyma in all but 1 patient. Fibrotic lesions were observed in 19 of 49 survivors (39%) with acute respiratory distress syndrome. Among 94 former ICU patients, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively. The left ventricular ejection fraction was less than 50% in 8 of 83 ICU patients (10%). New-onset chronic kidney disease was observed in 2 ICU patients. Serology was positive in 172 of 177 outpatients (97%).
Four months after hospitalization for COVID-19, a cohort of patients frequently reported symptoms not previously present, and lung-scan abnormalities were common among those who were tested. These findings are limited by the absence of a control group and of pre-COVID assessments in this cohort. Further research is needed to understand longer-term outcomes and whether these findings reflect associations with the disease.
关于 COVID-19 的长期后果知之甚少。
描述 COVID-19 住院患者在 4 个月时的后果。
设计、地点和参与者：在一项前瞻性非对照队列研究中，2020 年 3 月 1 日至 5 月 29 日期间在法国一所大学医院住院的 COVID-19 幸存者在出院后 4 个月（2020 年 7 月 15 日至 9 月 18 日）接受了电话评估。所有因相关症状住院且所有入住重症监护病房（ICU）的患者均在门诊就诊时进一步评估。
COVID-19 住院治疗的存活情况。
通过电话使用 Q3PC 认知筛查问卷和症状清单评估呼吸、认知和功能症状。在门诊就诊时，患者接受了肺功能测试、肺部计算机断层扫描、心理测量和认知测试（包括 36 项简短健康调查和 20 项多维疲劳量表），对于曾入住 ICU 或报告持续症状的患者，还进行了超声心动图检查。
在 834 名合格患者中，有 478 名通过电话进行了评估（平均年龄为 61 岁[标准差为 16 岁]；201 名男性，277 名女性）。在电话访谈中，244 名患者（51%）报告了至少 1 种以前不存在的症状：疲劳占 31%，认知症状占 21%，新发呼吸困难占 16%。对 177 名患者（37%）进行了进一步评估，包括 142 名前 ICU 患者中的 97 名。（n=130）20 项多维疲劳量表的中位数评分为 4.5（四分位距，3.0-5.0），表示动机降低；精神疲劳评分为 3.7（四分位距，3.0-4.5）（可能范围，1[最佳]至 5[最差]）。36 项简短健康调查的中位数评分（n=145）为 25（四分位距，25.0-75.0），表示“因身体问题导致的角色受限”亚量表（可能范围，0[最佳]至 100[最差]）。在 171 名患者中的 108 名（63%）发现了肺部计算机断层扫描异常，主要为轻微磨玻璃影。在 171 名患者中观察到 33 例（19%）纤维性病变，除 1 名患者外，所有患者的病变均累及小于 25%的实质。在 49 名急性呼吸窘迫综合征幸存者中有 19 名（39%）观察到纤维性病变。在 94 名前 ICU 患者中，分别有 23%、18%和 7%观察到焦虑、抑郁和创伤后症状。83 ICU 患者中有 8 名（10%）左心室射血分数小于 50%。2 名 ICU 患者出现新发慢性肾脏病。在 177 名门诊患者中有 172 名（97%）血清学检测呈阳性。
COVID-19 住院 4 个月后，一组患者经常报告以前不存在的症状，且肺部扫描异常在接受测试的患者中较为常见。这些发现受到该队列缺乏对照组和 COVID-19 前评估的限制。需要进一步研究以了解长期结果，以及这些发现是否反映了与疾病的关联。
