重症 COVID-19 幸存者：功能、身体、心理和认知结局如何演变？
Surviving critical COVID-19: How functionality, physical, mental and cognitive outcomes evolve?
机构信息
Physical Medicine and Rehabilitation Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
Intensive Care Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
出版信息
PLoS One. 2023 Jun 23;18(6):e0284597. doi: 10.1371/journal.pone.0284597. eCollection 2023.
PURPOSE
To analyze the long-term consequences of critical COVID-19, regarding physical, mental, cognitive and functional impairments, and to describe its evolution through time.
METHODS
Prospective cohort study, with consecutive inclusion of patients admitted due to SARS-CoV-2 to intensive care units(ICU) of a tertiary-care center, between May/2020 and September/2021. All included patients were included in Physical and Rehabilitation Medicine(PRM) inpatient programs during ICU stay. Eligible patients were evaluated on PRM appointments 6 and 12 months after ICU discharge. In each visit, physical examination and a predefined set of scales were applied, aiming to comprehensively evaluate the three domains (physical, mental and cognitive) of post-intensive care syndrome and the patients' functionality. Statistical analysis encompassed descriptive and univariate analysis.
RESULTS
A total of 42 patients were included: 66.7% males, mean age of 62 yo. In the physical domain, 6 months after ICU discharge, there was a significant reduction in quality of life (p-value = 0.034), muscle strength (p-value = 0.002), gait ability (p-value<0.001) and balance (p-values<0.001) and increased fatigue levels (p-value = 0.009), in comparison with reference values. Yet, a significative positive evolution was observed in all referred subdomains (p-values<0.05). Nevertheless, 12 months after discharge, muscle strength (p-value = 0.001), gait (p-value<0.001) and balance (p-value<0.001) were still significantly compromised. Regarding the mental domain, both at 6 and 12 months after discharge, the levels of anxiety and depression were significantly increased (p-values<0.001). Nonetheless, a positive evolution was also found (p-values<0.02). Cognitive performance was significantly impaired in comparison with reference values, both at 6 and 12 months (p-value<0.001). Yet, a global improvement was also depicted (p-value = 0.003). Six months after ICU discharge, 54.8% were autonomous in activities of daily living, a value that improved to 74.0% in the subsequent 6 months (p-value = 0.002).
CONCLUSION
Critical COVID-19 survivors present significant physical, mental and cognitive impairments 6 and 12 months after ICU discharge, despite their positive evolution through time.
目的
分析 COVID-19 重症患者的长期后果，包括身体、心理、认知和功能障碍，并描述其随时间的演变。
方法
前瞻性队列研究，连续纳入 2020 年 5 月至 2021 年 9 月期间因 SARS-CoV-2 入住三级护理中心重症监护病房（ICU）的患者。所有纳入的患者在 ICU 期间均接受物理康复医学（PRM）住院治疗。符合条件的患者在 ICU 出院后 6 个月和 12 个月接受 PRM 预约评估。在每次就诊时，进行体格检查和一组预先确定的量表，旨在全面评估 ICU 后综合征的三个领域（身体、心理和认知）和患者的功能。统计分析包括描述性和单变量分析。
结果
共纳入 42 名患者：66.7%为男性，平均年龄为 62 岁。在身体领域，与参考值相比，ICU 出院后 6 个月时，生活质量（p 值=0.034）、肌肉力量（p 值=0.002）、步态能力（p 值<0.001）和平衡（p 值<0.001）显著降低，疲劳水平增加（p 值=0.009）。然而，所有相关亚领域都观察到显著的积极演变（p 值<0.05）。然而，出院后 12 个月时，肌肉力量（p 值=0.001）、步态（p 值<0.001）和平衡（p 值<0.001）仍显著受损。关于心理领域，出院后 6 个月和 12 个月时，焦虑和抑郁水平均显著升高（p 值<0.001）。然而，也发现了积极的演变（p 值<0.02）。与参考值相比，认知表现也在 6 个月和 12 个月时均显著受损（p 值<0.001）。然而，也描绘了整体改善（p 值=0.003）。ICU 出院后 6 个月时，54.8%的患者日常生活活动能力自主，随后 6 个月时这一比例提高至 74.0%（p 值=0.002）。
结论
COVID-19 重症幸存者在 ICU 出院后 6 个月和 12 个月时仍存在显著的身体、心理和认知障碍，尽管他们随时间的演变呈现出积极的趋势。
Zotero 插件