Legrand Matthieu, Fong Nicholas, Laouénan Cédric, Ghosn Jade, Thill Benoit, Faure Karine, Garot Denis, Goujard Cécile, Curlier Elodie, Resche-Rigon Matthieu, Rossignol Patrick, Pirracchio Romain
Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA.
School of Medicine, University of California, San Francisco, California, USA.
BMJ Med. 2022 Jun 17;1(1):e000093. doi: 10.1136/bmjmed-2021-000093. eCollection 2022.
To investigate risk factors and subphenotypes associated with long term symptoms and outcomes after hospital admission for covid-19.
Prospective, multicentre observational study.
93 hospitals in France.
Data from 2187 adults admitted to hospital with covid-19 in France between 1 February 2020 and 30 June 2021.
Primary endpoint was the total number of persistent symptoms at six months after hospital admission that were not present before admission. Outcomes examined at six months were persistent symptoms, Hospital Anxiety and Depression Scale, six minute walk test distances, 36-Item Short Form Health Survey scores, and ability to resume previous professional activities and self-care. Secondary endpoints included vital status at six months, and results of standardised quality-of-life scores. Additionally, an unsupervised consensus clustering algorithm was used to identify subphenotypes based on the severity of hospital course received by patients.
1109 (50.7%) of 2187 participants had at least one persistent symptom. Factors associated with an increased number of persistent symptoms were in-hospital supplemental oxygen (odds ratio 1.12, 95% confidence interval 1 to 1.24), no intensive care unit admission (1.15, 1.01 to 1.32), female sex (1.33, 1.22 to 1.45), gastrointestinal haemorrhage (1.51, 1.02 to 2.23), a thromboembolic event (1.66, 1.17 to 2.34), and congestive heart failure (1.76, 1.27 to 2.43). Three subphenotypes were identified: including patients with the least severe hospital course (based on ventilatory support requirements). Although Hospital Anxiety and Depression Scale scores were within normal values for all groups, patients of intermediate severity and more comorbidities had a higher median Hospital Anxiety and Depression Scale score than did the other subphenotypes. Patients in the subphenotype with most severe hospital course had worse short form-36 scores and were less able to resume their professional activity or care for themselves as before compared with other subphenotypes.
Persistent symptoms after hospital admission were frequent, regardless of acute covid-19 severity. However, patients in more severe subphenotypes had a significantly worse functional status and were less likely to resume their professional activity or able to take care of themselves as before.
NCT04262921.
调查新型冠状病毒肺炎（COVID-19）住院后长期症状及预后的危险因素和亚表型。
前瞻性、多中心观察性研究。
法国的93家医院。
2020年2月1日至2021年6月30日期间在法国因COVID-19住院的2187名成年人的数据。
主要终点为住院6个月后出现的、入院前不存在的持续症状总数。6个月时检查的结局包括持续症状、医院焦虑抑郁量表、6分钟步行试验距离、简明健康状况调查36项评分，以及恢复先前职业活动和自我护理的能力。次要终点包括6个月时的生命状态和标准化生活质量评分结果。此外，使用无监督一致性聚类算法根据患者接受的住院病程严重程度识别亚表型。
2187名参与者中有1109名（50.7%）至少有一种持续症状。与持续症状数量增加相关的因素包括住院期间补充氧气（比值比1.12，95%置信区间1至1.24）、未入住重症监护病房（1.15，1.01至1.32）、女性（1.33，1.22至1.45）、胃肠道出血（1.51，1.02至2.23）、血栓栓塞事件（1.66，1.17至2.34）和充血性心力衰竭（1.76，1.27至2.43）。识别出三种亚表型：包括住院病程最轻的患者（基于通气支持需求）。尽管所有组的医院焦虑抑郁量表评分均在正常范围内，但中度严重程度且合并症较多的患者的医院焦虑抑郁量表中位数评分高于其他亚表型。与其他亚表型相比，住院病程最严重的亚表型患者的简明健康状况调查36项评分更差，恢复职业活动或像以前一样自我护理的能力更低。
无论急性COVID-19的严重程度如何，住院后持续症状都很常见。然而，更严重亚表型的患者功能状态明显更差，恢复职业活动或像以前一样自我护理的可能性更小。
NCT04262921。
