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基于智能手机的SARS-CoV-2相关呼吸衰竭出院后症状纵向监测:一项多中心观察性研究

Longitudinal Smartphone-Based Post-hospitalisation Symptom Monitoring in SARS-CoV-2 Associated Respiratory Failure: A Multi-Centre Observational Study.

作者信息

Kohlbrenner Dario, Kuhn Manuel, Stüssi-Helbling Melina, Nordmann Yves, Spielmanns Marc, Clarenbach Christian F

机构信息

Faculty of Medicine, University of Zurich, Zurich, Switzerland.

Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.

出版信息

Front Rehabil Sci. 2021 Nov 24;2:777396. doi: 10.3389/fresc.2021.777396. eCollection 2021.

Abstract

We aimed to longitudinally monitor the recovery in breathlessness, symptom burden, health-related quality-of-life, and mental health status in individuals hospitalised due to SARS-CoV-2 associated respiratory failure. Individuals hospitalised due to SARS-CoV-2 associated respiratory failure were recruited at hospital discharge in three participating centres. During the 90 day follow-up, European Quality of Life-5 Dimensions-5 Levels Instrument (EQ-5D-5L), modified Medical Research Council (mMRC) Dyspnoea Scale, COPD Assessment Test (CAT), and weekly Hospital Anxiety and Depression Scale (HADS) questionnaires were assessed using a smartphone application. The results were presented using descriptive statistics and graphics. Linear mixed models with random intercept were fitted to analyse differences of intensive-care unit status on the recovery course in each outcome. We included 58 participants, 40 completed the study. From hospital discharge until 90 days post-discharge, EQ-5D-5L index changed from 0.83 (0.66, 0.92) to 0.96 (0.82, 1.0), VAS rating on general health status changed from 62 (50, 75) % to 80 (74, 94) %, CAT changed from 13 (10, 21) to 7 (3, 11) points, mMRC changed from 1 (0, 2) to 0 (0, 1) points, HADS depression subscale changed from 6 (4, 9) to 5 (1, 6) points, HADS anxiety subscale changed from 7 (3, 9) to 2 (1, 8) points. Differences in the recovery courses were observed between intensive-care and ward participants. Participants that were admitted to an intensive-care unit during their hospitalisation ( = 16) showed increases in CAT, mMRC, HADS scores, and decreases in EQ-5D-5L 30 days after hospital discharge. Being admitted to an ICU led to statistically significant reductions in recovery in the EQ-5D-5L and the CAT. Furthermore, the flare-up in symptom burden and depression scores, accompanied by an attenuated recovery in HrQoL and general health status in the ICU-group suggests that a clinical follow-up 1 month after hospital discharge can be recommended, evaluating further treatments. [www.ClinicalTrials.gov], identifier [NCT04365595].

摘要

我们旨在纵向监测因SARS-CoV-2相关呼吸衰竭住院的个体在呼吸困难、症状负担、健康相关生活质量和心理健康状况方面的恢复情况。在三个参与中心,对因SARS-CoV-2相关呼吸衰竭住院的个体在出院时进行招募。在90天的随访期间,使用智能手机应用程序评估欧洲生活质量五维度五级量表(EQ-5D-5L)、改良医学研究委员会(mMRC)呼吸困难量表、慢性阻塞性肺疾病评估测试(CAT)以及每周的医院焦虑抑郁量表(HADS)问卷。结果采用描述性统计和图表呈现。采用具有随机截距的线性混合模型分析重症监护病房状态对各结局恢复过程的差异。我们纳入了58名参与者,40名完成了研究。从出院到出院后90天,EQ-5D-5L指数从0.83(0.66,0.92)变为0.96(0.82,1.0),总体健康状况的视觉模拟评分(VAS)从62(50,75)%变为80(74,94)%,CAT从13(10,21)分变为7(3,11)分,mMRC从1(0,2)分变为0(0,1)分,HADS抑郁子量表从6(4,9)分变为5(1,6)分,HADS焦虑子量表从7(3,9)分变为2(1,8)分。在重症监护病房参与者和病房参与者之间观察到恢复过程的差异。住院期间入住重症监护病房的参与者(n = 16)在出院30天后CAT、mMRC、HADS评分升高,EQ-5D-5L降低。入住重症监护病房导致EQ-5D-5L和CAT的恢复在统计学上显著降低。此外,重症监护病房组症状负担和抑郁评分的突然增加,伴随着健康相关生活质量和总体健康状况恢复的减弱,表明出院后1个月可建议进行临床随访,评估进一步治疗。[www.ClinicalTrials.gov],标识符[NCT04365595]

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5767/9397765/c8bb20d3190b/fresc-02-777396-g0001.jpg

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