新型冠状病毒肺炎（COVID-19）住院后出现COVID-19后呼吸困难的特征及危险因素
Characteristics and risk factors for post-COVID-19 breathlessness after hospitalisation for COVID-19.
作者信息
Daines Luke, Zheng Bang, Elneima Omer, Harrison Ewen, Lone Nazir I, Hurst John R, Brown Jeremy S, Sapey Elizabeth, Chalmers James D, Quint Jennifer K, Pfeffer Paul, Siddiqui Salman, Walker Samantha, Poinasamy Krisnah, McAuley Hamish, Sereno Marco, Shikotra Aarti, Singapuri Amisha, Docherty Annemarie B, Marks Michael, Toshner Mark, Howard Luke S, Horsley Alex, Jenkins Gisli, Porter Joanna C, Ho Ling-Pei, Raman Betty, Wain Louise V, Brightling Christopher E, Evans Rachael A, Heaney Liam G, De Soyza Anthony, Sheikh Aziz
机构信息
Usher Institute, University of Edinburgh, Edinburgh, UK.
The Institute for Lung Health, Leicester NIHR Biomedical Research Centre, University of Leicester, Leicester, UK.
出版信息
ERJ Open Res. 2023 Feb 20;9(1). doi: 10.1183/23120541.00274-2022. eCollection 2023 Jan.
BACKGROUND
Persistence of respiratory symptoms, particularly breathlessness, after acute coronavirus disease 2019 (COVID-19) infection has emerged as a significant clinical problem. We aimed to characterise and identify risk factors for patients with persistent breathlessness following COVID-19 hospitalisation.
METHODS
PHOSP-COVID is a multicentre prospective cohort study of UK adults hospitalised for COVID-19. Clinical data were collected during hospitalisation and at a follow-up visit. Breathlessness was measured by a numeric rating scale of 0-10. We defined post-COVID-19 breathlessness as an increase in score of ≥1 compared to the pre-COVID-19 level. Multivariable logistic regression was used to identify risk factors and to develop a prediction model for post-COVID-19 breathlessness.
RESULTS
We included 1226 participants (37% female, median age 59 years, 22% mechanically ventilated). At a median 5 months after discharge, 50% reported post-COVID-19 breathlessness. Risk factors for post-COVID-19 breathlessness were socioeconomic deprivation (adjusted OR 1.67, 95% CI 1.14-2.44), pre-existing depression/anxiety (adjusted OR 1.58, 95% CI 1.06-2.35), female sex (adjusted OR 1.56, 95% CI 1.21-2.00) and admission duration (adjusted OR 1.01, 95% CI 1.00-1.02). Black ethnicity (adjusted OR 0.56, 95% CI 0.35-0.89) and older age groups (adjusted OR 0.31, 95% CI 0.14-0.66) were less likely to report post-COVID-19 breathlessness. Post-COVID-19 breathlessness was associated with worse performance on the shuttle walk test and forced vital capacity, but not with obstructive airflow limitation. The prediction model had fair discrimination (concordance statistic 0.66, 95% CI 0.63-0.69) and good calibration (calibration slope 1.00, 95% CI 0.80-1.21).
CONCLUSIONS
Post-COVID-19 breathlessness was commonly reported in this national cohort of patients hospitalised for COVID-19 and is likely to be a multifactorial problem with physical and emotional components.
背景
2019年冠状病毒病（COVID-19）急性感染后呼吸道症状，尤其是呼吸困难的持续存在已成为一个重大的临床问题。我们旨在对COVID-19住院后持续存在呼吸困难的患者进行特征描述并确定其危险因素。
方法
PHOSP-COVID是一项针对因COVID-19住院的英国成年人的多中心前瞻性队列研究。在住院期间和随访时收集临床数据。呼吸困难通过0至10的数字评分量表进行测量。我们将COVID-19后呼吸困难定义为与COVID-19前水平相比评分增加≥1分。采用多变量逻辑回归来识别危险因素并建立COVID-19后呼吸困难的预测模型。
结果
我们纳入了1226名参与者（女性占37%，中位年龄59岁，22%接受机械通气）。出院后中位5个月时，50%的人报告有COVID-19后呼吸困难。COVID-19后呼吸困难的危险因素包括社会经济剥夺（调整后的比值比为1.67，95%置信区间为1.14 - 2.44）、既往有抑郁/焦虑（调整后的比值比为1.58，95%置信区间为1.06 - 2.35）、女性（调整后的比值比为1.56，95%置信区间为1.21 - 2.00）和住院时间（调整后的比值比为1.01，95%置信区间为1.00 - 1.02）。黑人种族（调整后的比值比为0.56，95%置信区间为0.35 - 0.89）和年龄较大的人群（调整后的比值比为0.31，95%置信区间为0.14 - 0.66）报告COVID-19后呼吸困难的可能性较小。COVID-19后呼吸困难与往返步行试验和用力肺活量的较差表现相关，但与阻塞性气流受限无关。该预测模型具有中等区分度（一致性统计量为0.66，95%置信区间为0.63 - 0.69）和良好的校准度（校准斜率为1.00，95%置信区间为0.80 - 1.21）。
结论
在这个因COVID-19住院的全国性队列患者中，COVID-19后呼吸困难很常见，并且可能是一个涉及身体和情感因素的多因素问题。
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