HealthPartners Institute, Bloomington, MN.
Kaiser Permanente Mid-Atlantic, Rockville, MD.
Med Care. 2023 May 1;61(5):288-294. doi: 10.1097/MLR.0000000000001842. Epub 2023 Mar 13.
BACKGROUND/OBJECTIVE: InFLUenza Patient-reported Outcome (FLU-PRO Plus) is a 34-item patient-reported outcome instrument designed to capture the intensity and frequency of viral respiratory symptoms. This study evaluates whether FLU-PRO Plus responses could discriminate between symptoms of coronavirus disease 2019 (COVID-19) and influenza-like illness (ILI) with no COVID diagnosis, as well as forecast disease progression.
FLU-PRO Plus was administered daily for 14 days. Exploratory factor analysis was used to reduce the FLU-PRO Plus responses on the first day to 3 factors interpreted as "symptom clusters." The 3 clusters were used to predict COVID-19 versus ILI diagnosis in logistic regression. Correlation between the clusters and quality of life (QoL) measures was used to assess concurrent validity. The timing of self-reported return to usual health in the 14-day period was estimated as a function of the clusters within COVID-19 and ILI groups.
Three hundred fourteen patients completed day 1 FLU-PRO Plus, of which 65% had a COVID-19 diagnosis. Exploratory factor analysis identified 3 symptom clusters: (1)general Body, (2) tracheal/bronchial, and (3) nasopharyngeal. Higher nasopharyngeal scores were associated with higher odds of COVID-19 compared with ILI diagnosis [adjusted odds ratio = 1.61 (1.21, 2.12)]. Higher tracheal/bronchial scores were associated with lower odds of COVID-19 [0.58 (0.44, 0.77)]. The 3 symptom clusters were correlated with multiple QoL measures ( r = 0.14-0.56). Higher scores on the general body and tracheal/bronchial symptom clusters were associated with prolonged time to return to usual health [adjusted hazard ratios: 0.76 (0.64, 0.91), 0.80 (0.67, 0.96)].
Three symptom clusters identified from FLU-PRO Plus responses successfully discriminated patients with COVID-19 from non-COVID ILI and were associated with QoL and predicted symptom duration.
背景/目的：流感患者报告结局量表（FLU-PRO Plus）是一个包含 34 个项目的患者报告结局量表，旨在捕捉病毒性呼吸道症状的强度和频率。本研究旨在评估 FLU-PRO Plus 应答是否能够区分 2019 冠状病毒病（COVID-19）与无 COVID 诊断的流感样疾病（ILI）的症状，以及预测疾病进展。
FLU-PRO Plus 在 14 天内每天进行评估。探索性因子分析用于将第 1 天的 FLU-PRO Plus 应答减少至 3 个解释为“症状群”的因子。使用逻辑回归预测 COVID-19 与 ILI 诊断。使用聚类与生活质量（QoL）测量之间的相关性来评估同时有效性。在 COVID-19 和 ILI 组中，将报告的 14 天内恢复正常健康的时间作为聚类的函数进行估计。
314 名患者完成了第 1 天的 FLU-PRO Plus，其中 65%有 COVID-19 诊断。探索性因子分析确定了 3 个症状群：（1）全身，（2）气管/支气管，（3）鼻咽。较高的鼻咽评分与 COVID-19 诊断的可能性较高相关，而与 ILI 诊断的可能性较低相关[调整后的优势比=1.61（1.21，2.12）]。较高的气管/支气管评分与 COVID-19 可能性较低相关[0.58（0.44，0.77）]。这 3 个症状群与多种 QoL 测量相关（r=0.14-0.56）。全身和气管/支气管症状群的较高评分与恢复到正常健康的时间延长相关[调整后的危险比：0.76（0.64，0.91），0.80（0.67，0.96）]。
从 FLU-PRO Plus 应答中确定的 3 个症状群成功地区分了 COVID-19 患者与非 COVID-19 ILI 患者，与 QoL 相关，并预测了症状持续时间。
