新冠后呼吸困难恢复的决定因素：对英国住院新冠患者和社区对照前瞻性队列的分析

Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls.

作者信息

Zheng Bang, Vivaldi Giulia, Daines Luke, Leavy Olivia C, Richardson Matthew, Elneima Omer, McAuley Hamish J C, Shikotra Aarti, Singapuri Amisha, Sereno Marco, Saunders Ruth M, Harris Victoria C, Houchen-Wolloff Linzy, Greening Neil J, Pfeffer Paul E, Hurst John R, Brown Jeremy S, Shankar-Hari Manu, Echevarria Carlos, De Soyza Anthony, Harrison Ewen M, Docherty Annemarie B, Lone Nazir, Quint Jennifer K, Chalmers James D, Ho Ling-Pei, Horsley Alex, Marks Michael, Poinasamy Krishna, Raman Betty, Heaney Liam G, Wain Louise V, Evans Rachael A, Brightling Christopher E, Martineau Adrian, Sheikh Aziz

机构信息

Usher Institute, University of Edinburgh, Edinburgh, UK.

Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.

出版信息

Lancet Reg Health Eur. 2023 Apr 28;29:100635. doi: 10.1016/j.lanepe.2023.100635. eCollection 2023 Jun.

DOI:10.1016/j.lanepe.2023.100635

PMID:37261214

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10145209/

Abstract

BACKGROUND

The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea.

METHODS

We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up.

FINDINGS

We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01-1.03), male (1.54, 1.16-2.04), neither obese nor severely obese (1.82, 1.06-3.13 and 4.19, 2.14-8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09-2.22) or cardiovascular disease (1.33, 1.00-1.79), and shorter hospital admission (1.01 per day, 1.00-1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission).

INTERPRETATION

Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19.

FUNDING

PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care.COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders.

摘要

背景

新冠病毒感染后呼吸困难恢复的风险因素尚不清楚。我们调查了新冠病毒感染成年患者呼吸困难恢复的决定因素，并将其与非新冠病毒感染所致呼吸困难恢复的决定因素进行比较。

方法

我们使用了两项前瞻性队列研究的数据：PHOSP-COVID（2020年3月至2021年4月因新冠病毒感染住院的患者）和英国COVIDENCE（同期研究的社区队列）。PHOSP-COVID的数据在住院期间以及5个月和1年随访时收集。英国COVIDENCE的数据通过基线和每月在线问卷获得。两个队列均使用医学研究理事会呼吸困难量表测量呼吸困难情况。我们使用多变量逻辑回归来确定与5个月至1年随访期间呼吸困难减轻相关的决定因素。

结果

我们纳入了990名PHOSP-COVID参与者和3309名英国COVIDENCE参与者。我们观察到，在PHOSP-COVID参与者中，年龄较小（每年优势比1.02，95%置信区间1.01 - 1.03）、男性（1.54，1.16 - 2.04）、既不肥胖也非重度肥胖（分别为1.82，1.06 - 3.13和4.19，2.14 - 8.19）、无既往焦虑或抑郁（1.56，1.09 - 2.22）或心血管疾病（1.33，1.00 - 1.79）以及住院时间较短（每天1.01，1.00 - 1.02）的参与者在5个月至1年随访期间症状改善的几率更高。在从非新冠病毒感染所致呼吸困难中恢复的患者中也发现了类似的关联，但年龄（和住院时间）除外。

解读

新冠病毒感染住院患者出院后1年呼吸困难恢复的相关因素与无新冠病毒感染的社区对照者相似。

资金来源

PHOSP-COVID由英国医学研究理事会-英国研究与创新部以及卫生和社会保健部通过国家卫生研究院（NIHR）应对新冠病毒的快速反应小组提供的赠款支持。出版物中表达的观点是作者的观点，不一定代表国民保健服务体系（NHS）、NIHR或卫生和社会保健部的观点。英国COVIDENCE由英国研究与创新部、国家卫生研究院和巴茨慈善机构支持。所表达的观点是作者的观点，不一定代表资助者的观点。