University College London Hospitals NHS Foundation Trust, London, UK.
University College London, London, UK.
BMJ Open Respir Res. 2021 Nov;8(1). doi: 10.1136/bmjresp-2021-001041.
Post-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients.
In a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression.
1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6-52.8) years vs 58.3 (47.0-67.7) years and 48.5 (39.4-55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118-298) days, 69 (51-111) days and 76 (55-128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%-85%). Less than half of employed individuals could return to work full time at first assessment.
Post-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.
新冠病毒感染后出现的并发症需要同时进行特征描述和管理，以制定政策和卫生系统应对措施。我们描述了英国首个专门的新冠病毒感染后临床服务的 12 个月经验，该服务涵盖了住院和非住院患者。
在单中心观察性分析中，我们报告了 2020 年 4 月至 2021 年 4 月期间在伦敦大学学院医院新冠病毒感染后服务中心接受评估的 1325 名个体的人口统计学特征、症状、合并症、检查、治疗、功能恢复、专科转诊和康复情况，并按转诊途径进行比较：住院后（PH）、非住院（NH）和急诊后（PED）。使用多变量逻辑回归评估与恢复不良或无法全职返回工作相关的症状。
共评估了 1325 名个体（PH：547 名，41.3%；PED：212 名，16%；NH：566 名，42.7%）。与 PH 和 PED 组相比，NH 组更年轻（中位数 44.6（35.6-52.8）岁 vs 58.3（47.0-67.7）岁和 48.5（39.4-55.7）岁），更可能为女性（68.2%、43.0%和 59.9%），少数民族比例更低（30.9%、52.7%和 41.0%），发病后就诊时间更晚（中位数（IQR）：194（118-298）天、69（51-111）天和 76（55-128）天；均 p<0.0001）。所有组的专科转诊率相似（NH 18.7%、PH 16.1%和 PED 18.9%，p=0.452），更可能需要呼吸急促支持（23.7%、5.5%和 15.1%，p<0.001）和疲劳（17.8%、4.8%和 8.0%，p<0.001）。住院患者的肺栓塞、持续性肺间质异常和其他器官损伤发生率更高。716 名（54.0%）个体报告的健康状况<75%（中位数 70%，IQR 55%-85%）。首次评估时，不到一半的就业个体能够全职返回工作。
PH 和 NH 患者的新冠病毒感染后症状显著，存在显著的持续医疗保健需求和利用。迫切需要针对干预措施和以患者为中心的诊断和治疗方法的路径进行试验。
