Holdsworth D A, Barker-Davies R M, Chamley R R, O'Sullivan O, Ladlow P, May S, Houston A D, Mulae J, Xie C, Cranley M, Sellon E, Naylor J, Halle M, Parati G, Davos C, Rider O J, Bennett A B, Nicol E D
Oxford University Hospitals NHS Foundation Trust, Oxford, UK
Royal Centre for Defence Medicine, Birmingham, UK.
BMJ Mil Health. 2024 Jul 24;170(4):308-314. doi: 10.1136/military-2022-002193.
Post-COVID-19 syndrome presents a health and economic challenge affecting ~10% of patients recovering from COVID-19. Accurate assessment of patients with post-COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings.
113 consecutive military patients were assessed in a comprehensive clinical pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CT pulmonary angiography and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease.
7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multidisciplinary team (MDT). These patients had reduced fitness (V̇O 26.7 (±5.1) vs 34.6 (±7.0) mL/kg/min; p=0.002) and functional capacity (peak power 200 (±36) vs 247 (±55) W; p=0.026) compared with those without significant disease. Simple CPET criteria (oxygen uptake (V̇O) >100% predicted and minute ventilation (VE)/carbon dioxide elimination (V̇CO) slope <30.0 or VE/V̇CO slope <35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83%, respectively (area under the receiver operating characteristic curve (AUC) 0.89). The addition of capillary blood gases to estimate alveolar-arterial gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease.
In a population recovering from SARS-CoV-2, there is reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, permit the exclusion of clinically significant disease.
新冠后综合征对约10%从新冠中康复的患者构成了健康和经济挑战。健康焦虑和同时出现的症状性自主神经功能障碍使对新冠后综合征患者的准确评估变得复杂。我们试图确定症状或客观的心肺运动试验是否能够预测具有临床意义的发现。
对113例连续的军事患者按照综合临床路径进行评估。这包括所有人的症状报告、病史、检查、肺功能测定、超声心动图和心肺运动试验（CPET），并在必要时进行胸部CT、双能CT肺血管造影和心脏磁共振成像。对症状、CPET结果以及是否存在重大病变进行了评估。分析数据以确定可用于排除重大疾病的诊断策略。
113例患者中有7例（6%）经心胸多学科团队（MDT）判定患有具有临床意义的疾病。与无重大疾病的患者相比，这些患者的体能下降（摄氧量（V̇O）为6.7（±5.1）vs 34.6（±7.0）mL/kg/min；p = 0.002）且功能能力下降（峰值功率为200（±36）vs 247（±55）W；p = 0.026）。简单的CPET标准（摄氧量（V̇O）>预测值的100%且分钟通气量（VE）/二氧化碳排出量（V̇CO）斜率<30.0或单独的VE/V̇CO斜率<35.0）排除重大疾病的敏感性和特异性分别为86%和83%（受试者操作特征曲线下面积（AUC）为0.89）。增加毛细血管血气分析以估计肺泡-动脉血氧分压差可将诊断性能提高到100%的敏感性和78%的特异性（AUC为0.92）。症状和肺功能测定无法区分重大疾病。
在从新冠病毒感染中康复的人群中，令人安心的是器官病变很少。CPET和功能能力测试而非报告的症状能够排除具有临床意义的疾病。
