Maglietta Giuseppe, Diodati Francesca, Puntoni Matteo, Lazzarelli Silvia, Marcomini Barbara, Patrizi Laura, Caminiti Caterina
Clinical and Epidemiological Research Unit, University Hospital of Parma, University of Parma, 43126 Parma, Italy.
J Clin Med. 2022 Mar 11;11(6):1541. doi: 10.3390/jcm11061541.
Evidence shows that a substantial proportion of patients with COVID-19 experiences long-term consequences of the disease, but the predisposing factors are poorly understood. We conducted a systematic review and meta-analysis to identify factors present during COVID-19 hospitalization associated with an increased risk of exhibiting new or persisting symptoms (Post-COVID-19 Syndrome, PCS). MedLine and WebOfScience were last searched on 30 September 2021. We included English language clinical trials and observational studies investigating prognostic factors for PCS in adults previously hospitalized for COVID-19, reporting at least one individual prospective follow-up of minimum 12 weeks. Two authors independently assessed risk of bias, which was judged generally moderate. Risk factors were included in the analysis if their association with PCS was investigated by at least two studies. To summarize the prognostic effect of each factor (or group of factors), odds ratios were estimated using raw data. Overall, 20 articles met the inclusion criteria, involving 13,340 patients. Associations were statistically significant for two factors: female sex with any symptoms (OR 1.52; 95% CI 1.27-1.82), with mental health symptoms (OR 1.67, 95% CI 1.21-2.29) and with fatigue (OR 1.54, 95% CI 1.32-1.79); acute disease severity with respiratory symptoms (OR 1.66, 95% CI 1.03-2.68). The I² statistics tests were calculated to quantify the degree of study heterogeneity. This is the first meta-analysis measuring the association between factors present during COVID-19 hospitalization and long-term sequelae. The role of female sex and acute disease severity as independent prognostic factors must be confirmed in robust longitudinal studies with longer follow-up. Identifying populations at greatest risk for PCS can enable the development of targeted prevention and management strategies. Systematic review registration: PROSPERO CRD42021253467.
有证据表明,相当一部分新冠病毒疾病(COVID-19)患者会经历该疾病的长期后果,但对其诱发因素却知之甚少。我们进行了一项系统综述和荟萃分析,以确定在COVID-19住院期间出现的、与出现新的或持续症状(新冠后综合征,PCS)风险增加相关的因素。MedLine和WebOfScience于2021年9月30日进行了最后一次检索。我们纳入了英文的临床试验和观察性研究,这些研究调查了先前因COVID-19住院的成年人中PCS的预后因素,报告了至少一项为期至少12周的个体前瞻性随访。两位作者独立评估了偏倚风险,结果判定总体为中度。如果至少两项研究调查了某个危险因素与PCS的关联,则将其纳入分析。为了总结每个因素(或因素组)的预后效应,使用原始数据估计比值比。总体而言,20篇文章符合纳入标准,涉及13340名患者。有两个因素的关联具有统计学意义:女性出现任何症状(比值比1.52;95%置信区间1.27 - 1.82)、出现心理健康症状(比值比1.67,95%置信区间1.21 - 2.29)以及出现疲劳(比值比1.54,95%置信区间1.32 - 1.79);急性疾病严重程度与呼吸道症状(比值比1.66,95%置信区间1.03 - 2.68)。计算I²统计量以量化研究异质性程度。这是第一项测量COVID-19住院期间出现的因素与长期后遗症之间关联的荟萃分析。女性性别和急性疾病严重程度作为独立预后因素的作用必须在随访时间更长的有力纵向研究中得到证实。识别出PCS风险最高的人群有助于制定有针对性的预防和管理策略。系统综述注册:PROSPERO CRD42021253467。