St George's University Hospitals NHS Foundation Trust, London, UK.
St George's University Hospitals NHS Foundation Trust, London, UK.
Respir Med. 2021 Nov;188:106602. doi: 10.1016/j.rmed.2021.106602. Epub 2021 Sep 8.
Survivors of COVID-19 infection may develop post-covid pulmonary fibrosis (PCF) and suffer from long term multi-system complications. The magnitude and risk factors associated with these are unknown.
We investigated the prevalence and risk factors associated with PCF and other complications in patients discharged after COVID-19 infection.
Patients had phone assessment 6 weeks post hospital discharge after COVID-19 infection using a set protocol. Those with significant respiratory symptoms were investigated with a CTPA, Pulmonary Function Tests and echocardiogram. Prevalence of myalgia, fatigue, psychological symptoms and PCF was obtained. Risk factors associated with these were investigated.
A large number of patients had persistent fatigue (45.1%), breathlessness (36.5%), myalgia (20.5%) and psychological symptoms (19.5%). PCF was seen in 9.5% of the patients and was associated with persistent breathlessness at 6 weeks and inpatient ventilation [adjusted OR 5.02(1.76-14.27) and 4.45(1.27-15.58)] respectively. It was more common in men and in patients with peak CRP >171.5 mg/L, peak WBC count ≥12 × 10 9/L, severe inpatient COVID-19 CXR changes and CT changes. Ventilation was also a risk factor for persisting fatigue and myalgia, the latter was also more common in those with severe cytokine storm and severe COVID-19 inpatient CXR changes.
All the patients discharged after COVID-19 should be assessed using a set protocol by a multidisciplinary team. Patients who had severe COVID-19 infection particularly those who were intubated and who have persistent breathlessness are at risk of developing PCF. They should have a CT Chest and have respiratory follow-up.
COVID-19 感染幸存者可能会发展为新冠后肺纤维化（PCF），并长期遭受多系统并发症的困扰。目前尚不清楚这些并发症的发生频率和相关风险因素。
我们旨在研究 COVID-19 感染出院患者中 PCF 及其他并发症的发生率和相关风险因素。
使用既定方案对 COVID-19 感染出院后 6 周的患者进行电话评估。对有明显呼吸道症状的患者进行 CT 肺动脉造影（CTPA）、肺功能检查和超声心动图检查。评估肌痛、疲劳、心理症状和 PCF 的发生率。分析与这些并发症相关的风险因素。
大量患者存在持续性疲劳（45.1%）、呼吸困难（36.5%）、肌痛（20.5%）和心理症状（19.5%）。9.5%的患者存在 PCF，与 6 周时持续性呼吸困难和住院期间通气有关[校正 OR 5.02（1.76-14.27）和 4.45（1.27-15.58）]。男性和 CRP 峰值＞171.5mg/L、白细胞计数峰值≥12×109/L、住院 COVID-19 CXR 改变和 CT 改变严重的患者中 PCF 更为常见。通气也是持续性疲劳和肌痛的风险因素，肌痛在细胞因子风暴严重和住院 COVID-19 CXR 改变严重的患者中更为常见。
所有 COVID-19 出院患者都应通过多学科团队使用既定方案进行评估。特别是那些住院时接受过插管和持续呼吸困难的严重 COVID-19 感染患者，有发展为 PCF 的风险。他们应进行胸部 CT 检查，并进行呼吸随访。
