Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2023 Jul 17;13(7):e071394. doi: 10.1136/bmjopen-2022-071394.
We aimed to compare long-term outcomes in intensive care unit (ICU) survivors between the first and second/third waves of the COVID-19 pandemic. More specifically, to assess health-related quality of life (HRQL) and respiratory health 6 months post-ICU and to study potential associations between patient characteristic and treatment variables regarding 6-month outcomes.
Prospective cohort study.
Single-centre study of adult COVID-19 patients with respiratory distress admitted to two Swedish ICUs during the first wave (1 March 2020-1 September 2020) and second/third waves (2 September 2020- 1 August 2021) with follow-up approximately 6 months after ICU discharge.
Critically ill COVID-19 patients who survived for at least 90 days.
HRQL, extent of residual changes on chest CT scan and pulmonary function were compared between the waves. General linear regression and multivariable logistic regression were used to present mean score differences (MSD) and ORs with 95% CIs.
Of the 456 (67%) critically ill COVID-19 patients who survived at least 90 days, 278 (61%) were included in the study. Six months after ICU discharge, HRQL was similar between survivors in the pandemic waves, except that the second/third wave survivors had better role physical (MSD 20.2, 95% CI 7.3 to 33.1, p<0.01) and general health (MSD 7.2, 95% CI 0.7 to 13.6, p=0.03) and less bodily pain (MSD 12.2, 95% CI 3.6 to 20.8, p<0.01), while first wave survivors had better diffusing capacity of the lungs for carbon monoxide (OR 1.9, 95% CI 1.1 to 3.5, p=0.03).
This study indicates that even though intensive care treatment strategies have changed with time, there are few differences in long-term HRQL and respiratory health seems to remain at 6 months for patients surviving critical COVID-19 in the first and second/third waves of the pandemic.
比较 COVID-19 大流行第一波和第二/第三波期间 ICU 幸存者的长期结局。更具体地说，评估 ICU 后 6 个月的健康相关生活质量（HRQL）和呼吸健康，并研究患者特征和治疗变量与 6 个月结局之间的潜在关联。
前瞻性队列研究。
在瑞典的两个 ICU 中，对患有呼吸窘迫的成年 COVID-19 患者进行了单中心研究，这些患者在第一波（2020 年 3 月 1 日至 2020 年 9 月 1 日）和第二/第三波（2020 年 9 月 2 日至 2021 年 8 月 1 日）期间接受了治疗，在 ICU 出院后大约 6 个月进行了随访。
至少存活 90 天的危重症 COVID-19 患者。
比较两波之间的 HRQL、胸部 CT 扫描上残留变化的程度和肺功能。使用一般线性回归和多变量逻辑回归来呈现平均得分差异（MSD）和 95%置信区间（CI）的 OR。
在至少存活 90 天的 456 名（67%）危重症 COVID-19 患者中，有 278 名（61%）被纳入研究。在 ICU 出院后 6 个月时，大流行波之间的幸存者的 HRQL 相似，只是第二/第三波的幸存者在角色身体（MSD 20.2，95%CI 7.3 至 33.1，p<0.01）和一般健康（MSD 7.2，95%CI 0.7 至 13.6，p=0.03）方面表现更好，身体疼痛（MSD 12.2，95%CI 3.6 至 20.8，p<0.01），而第一波幸存者的一氧化碳弥散能力更好（OR 1.9，95%CI 1.1 至 3.5，p=0.03）。
这项研究表明，尽管随着时间的推移，重症监护治疗策略发生了变化，但在 COVID-19 大流行的第一波和第二/第三波中，长期 HRQL 方面几乎没有差异，而且似乎在 6 个月时，存活下来的危重症 COVID-19 患者的呼吸健康状况保持稳定。
