SARS-CoV-2 肺炎的基层医疗随访和长新冠：马德里市的回顾性观察研究。
SARS-CoV-2 pneumonia follow-up and long COVID in primary care: A retrospective observational study in Madrid city.
机构信息
Federica Montseny Primary Health Care Center, Gerencia Asistencial Atención Primaria, Madrid Health Service, Madrid, Spain.
Servicio de Atención Rural Norte, Gerencia Asistencial Atención Primaria, Madrid Health Service, Madrid, Spain.
出版信息
PLoS One. 2021 Sep 22;16(9):e0257604. doi: 10.1371/journal.pone.0257604. eCollection 2021.
BACKGROUND
Patients with COVID-19 are follow-up in primary care and long COVID is scarcely defined. The study aim was to describe SARS-CoV-2 pneumonia and cut-offs for defining long COVID in primary care follow-up patients.
METHODS
A retrospective observational study in primary care in Madrid, Spain, was conducted. Data was collected during 6 months (April to September) in 2020, during COVID-19 first wave, from patients ≥ 18 years with SARS-CoV-2 pneumonia diagnosed. Variables: sociodemographic, comorbidities, COVID-19 symptoms and complications, laboratory test and chest X-ray. Descriptive statistics were used, mean (standard deviation (SD)) and medians (interquartile range (IQR)) respectively. Differences were detected applying X2 test, Student's T-test, ANOVA, Wilcoxon-Mann-Whitney or Kruskal-Wallis depending on variable characteristics.
RESULTS
155 patients presented pneumonia in day 7.8 from the onset (79.4% were hospitalized, median length of 7.0 days (IQR: 3.0, 13.0)). After discharge, the follow-up lasted 54.0 median days (IQR 42.0, 88.0) and 12.2 mean (SD 6.4) phone calls were registered per patient. The main symptoms and their duration were: cough (41.9%, 12 days), dyspnoea (31.0%, 15 days), asthenia (26.5%, 21 days). Different cut-off points were applied for long COVID and week 4 was considered the best milestone (28.3% of the sample still had symptoms after week 4) versus week 12 (8.3%). Patients who still had symptoms >4 weeks follow-up took place over 81.0 days (IQR: 50.5, 103.0), their symptoms were more prevalent and lasted longer than those ≤ 4 weeks: cough (63.6% 30 days), dyspnoea (54.6%, 46 days), and asthenia (56.8%, 29 days). Embolism was more frequent in patients who still had symptoms >4 weeks than those with symptoms ≤4 weeks (9.1% vs 1.8%, p value 0.034).
CONCLUSION
Most patients with SARS-CoV-2 pneumonia recovered during the first 4 weeks from the beginning of the infection. The cut-off point to define long COVID, as persisting symptoms, should be between 4 to 12 weeks from the onset of the symptoms.
背景
患有 COVID-19 的患者在基层医疗机构接受随访，而长新冠的定义尚不明确。本研究旨在描述 SARS-CoV-2 肺炎，并为基层医疗机构随访患者中长新冠的定义制定截断值。
方法
这是在西班牙马德里的基层医疗机构中进行的一项回顾性观察性研究。在 2020 年 COVID-19 第一波期间的 6 个月（4 月至 9 月）内，收集了≥18 岁的 SARS-CoV-2 肺炎确诊患者的数据。变量包括社会人口统计学、合并症、COVID-19 症状和并发症、实验室检查和胸部 X 线。使用描述性统计，分别表示均值（标准差（SD））和中位数（四分位距（IQR））。根据变量特征，应用卡方检验、学生 t 检验、方差分析、Wilcoxon-Mann-Whitney 检验或 Kruskal-Wallis 检验来检测差异。
结果
155 名患者在发病后第 7.8 天出现肺炎（79.4%住院，中位住院时间为 7.0 天（IQR：3.0，13.0））。出院后，随访持续了 54.0 天（IQR 42.0，88.0），每名患者平均（SD 6.4）记录了 12.2 次电话随访。主要症状及其持续时间如下：咳嗽（41.9%，12 天）、呼吸困难（31.0%，15 天）、乏力（26.5%，21 天）。对于长新冠，应用了不同的截断值，第 4 周被认为是最佳的里程碑（4 周后仍有症状的样本占 28.3%），而第 12 周（8.3%）则不然。仍有症状>4 周的患者的症状持续时间超过 81.0 天（IQR：50.5，103.0），其症状比症状持续时间≤4 周的患者更为普遍和持续时间更长：咳嗽（63.6%，30 天）、呼吸困难（54.6%，46 天）和乏力（56.8%，29 天）。仍有症状>4 周的患者中发生栓塞的频率高于症状持续时间≤4 周的患者（9.1%比 1.8%，p 值为 0.034）。
结论
大多数患有 SARS-CoV-2 肺炎的患者在感染开始后的第 4 周内康复。作为长新冠定义的持续症状的截断值，应在症状出现后的 4 至 12 周之间。
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