长新冠疾病疲劳的风险因素和多维评估：巢式病例对照研究。
Risk Factors and Multidimensional Assessment of Long Coronavirus Disease Fatigue: A Nested Case-Control Study.
机构信息
Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
COVID Recovery Clinic, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.
出版信息
Clin Infect Dis. 2022 Nov 14;75(10):1688-1697. doi: 10.1093/cid/ciac283.
BACKGROUND
Fatigue is the most prevalent and debilitating long-COVID (coronavirus disease) symptom; however, risk factors and pathophysiology of this condition remain unknown. We assessed risk factors for long-COVID fatigue and explored its possible pathophysiology.
METHODS
This was a nested case-control study in a COVID recovery clinic. Individuals with (cases) and without (controls) significant fatigue were included. We performed a multidimensional assessment evaluating various parameters, including pulmonary function tests and cardiopulmonary exercise testing, and implemented multivariable logistic regression to assess risk factors for significant long-COVID fatigue.
RESULTS
A total of 141 individuals were included. The mean age was 47 (SD: 13) years; 115 (82%) were recovering from mild coronavirus disease 2019 (COVID-19). Mean time for evaluation was 8 months following COVID-19. Sixty-six (47%) individuals were classified with significant long-COVID fatigue. They had a significantly higher number of children, lower proportion of hypothyroidism, higher proportion of sore throat during acute illness, higher proportions of long-COVID symptoms, and of physical limitation in daily activities. Individuals with long-COVID fatigue also had poorer sleep quality and higher degree of depression. They had significantly lower heart rate [153.52 (22.64) vs 163.52 (18.53); P = .038] and oxygen consumption per kilogram [27.69 (7.52) vs 30.71 (7.52); P = .036] at peak exercise. The 2 independent risk factors for fatigue identified in multivariable analysis were peak exercise heart rate (OR: .79 per 10 beats/minute; 95% CI: .65-.96; P = .019) and long-COVID memory impairment (OR: 3.76; 95% CI: 1.57-9.01; P = .003).
CONCLUSIONS
Long-COVID fatigue may be related to autonomic dysfunction, impaired cognition, and decreased mood. This may suggest a limbic-vagal pathophysiology.
CLINICAL TRIALS REGISTRATION
NCT04851561.
背景
疲劳是最常见和最具破坏性的长新冠（冠状病毒病）症状；然而，这种疾病的危险因素和病理生理学仍不清楚。我们评估了长新冠疲劳的危险因素，并探讨了其可能的病理生理学。
方法
这是在新冠康复诊所进行的嵌套病例对照研究。纳入有（病例）和无（对照）显著疲劳的个体。我们进行了多维评估，评估了各种参数，包括肺功能测试和心肺运动测试，并实施了多变量逻辑回归来评估长新冠疲劳的危险因素。
结果
共纳入 141 人。平均年龄为 47（标准差：13）岁；115（82%）人从轻度 2019 年冠状病毒病（COVID-19）中康复。评估时间平均为 COVID-19 后 8 个月。66（47%）人被归类为有显著的长新冠疲劳。他们的孩子数量明显更多，甲状腺功能减退的比例较低，急性疾病期间喉咙痛的比例较高，长新冠症状和日常活动中身体受限的比例较高。长新冠疲劳的人睡眠质量也较差，抑郁程度较高。他们的心率明显较低[153.52（22.64）比 163.52（18.53）；P=.038]和运动峰值时每公斤耗氧量[27.69（7.52）比 30.71（7.52）；P=.036]。多变量分析确定的疲劳的 2 个独立危险因素是运动峰值时的心率[每 10 次/分钟降低 0.79；95%置信区间：0.65-0.96；P=.019]和长新冠记忆障碍（比值比：3.76；95%置信区间：1.57-9.01；P=.003）。
结论
长新冠疲劳可能与自主神经功能障碍、认知障碍和情绪低落有关。这可能提示边缘-迷走神经病理生理学。
临床试验注册
NCT04851561。
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