Critical Care, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom.
Department of Respiratory Medicine, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom.
Clin Infect Dis. 2022 Jan 29;74(2):301-308. doi: 10.1093/cid/ciab341.
The medium- and long-term effects of severe acute respiratory syndrome coronavirus 2 infection on survivors are unknown. In the current study, we assessed the medium-term effects of coronavirus disease 2019 (COVID-19) on survivors of severe disease.
This is a retrospective, case series of 200 patients hospitalized across 3 large Birmingham hospitals with severe-to-critical COVID-19 infection 4-7 months from disease onset. Patients underwent comprehensive clinical, laboratory, imaging, lung function tests (LFTs), and quality of life and cognitive assessments.
At 4-7 months after disease onset, 63.2% of patients reported persistent breathlessness; 53.5%, significant fatigue; 37.5%, reduced mobility; and 36.8% pain. Serum markers of inflammation and organ injuries that persisted at hospital discharge had normalized on follow-up, indicating no sustained immune response causing chronic maladaptive inflammation. Chest radiographs showed complete resolution in 82.8%, and significant improvement or no change in 17.2%. LFTs revealed gas transfer abnormalities in 80.0% and abnormal spirometric values in 37.6% of patients. Compared with patients who did not experience breathlessness, those who did had significantly higher incidences of comorbid conditions and residual chest radiographic and LFT abnormalities (P < .01 to all). For all parameters assessed and persisting symptoms there were no significant differences between patients in hospital wards and those in intensive treatment units. All patients reported a significantly reduced quality of life in all domains of the EQ-5D-5L quality-of-life measures.
A significant proportion of severely ill patients with COVID-19 still experience symptoms of breathlessness, fatigue, pain, reduced mobility, depression and reduced quality of life 4-7 months after disease onset. Symptomatic patients tend to have more residual chest radiographic and LFT abnormalities.
严重急性呼吸综合征冠状病毒 2 感染对幸存者的中长期影响尚不清楚。在本研究中，我们评估了 200 例在发病后 4-7 个月在 3 家大伯明翰医院住院的严重至危重新冠肺炎（COVID-19）幸存者的中期影响。患者接受了全面的临床、实验室、影像学、肺功能测试（LFT）以及生活质量和认知评估。
这是一项回顾性病例系列研究，纳入了 3 家大伯明翰医院的 200 名严重至危重新冠肺炎患者，发病后 4-7 个月。患者接受了全面的临床、实验室、影像学、肺功能测试（LFT）以及生活质量和认知评估。
在发病后 4-7 个月时，63.2%的患者报告持续性呼吸困难；53.5%的患者报告显著疲劳；37.5%的患者报告活动能力下降；36.8%的患者报告疼痛。在出院时持续存在的血清炎症和器官损伤标志物在随访中已恢复正常，表明没有持续的免疫反应导致慢性适应性炎症。82.8%的患者胸部 X 线片完全恢复，17.2%的患者有明显改善或无变化。LFT 显示 80.0%的患者有气体转移异常，37.6%的患者有异常的肺功能值。与没有呼吸困难的患者相比，有呼吸困难的患者更易发生合并症以及胸部影像学和 LFT 异常（所有 P 值均<0.01）。对于所有评估的参数和持续存在的症状，住院病房和重症监护病房的患者之间没有显著差异。所有患者报告说，在所有 EQ-5D-5L 生活质量测量维度中，生活质量都明显下降。
在发病后 4-7 个月，相当一部分 COVID-19 重症患者仍有呼吸困难、疲劳、疼痛、活动能力下降、抑郁和生活质量下降的症状。有症状的患者往往有更多的残余胸部影像学和 LFT 异常。
