社会经济地位对新型冠状病毒肺炎所致急性呼吸窘迫综合征后功能恢复的影响：多中心观察性RECOVIDS研究
Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study.
作者信息
Declercq Pierre-Louis, Fournel Isabelle, Demeyere Matthieu, Berraies Anissa, Ksiazek Eléa, Nyunga Martine, Daubin Cédric, Ampere Alexandre, Sauneuf Bertrand, Badie Julio, Delbove Agathe, Nseir Saad, Artaud-Macari Elise, Bironneau Vanessa, Ramakers Michel, Maizel Julien, Miailhe Arnaud-Felix, Lacombe Béatrice, Delberghe Nicolas, Oulehri Walid, Georges Hugues, Tchenio Xavier, Clarot Caroline, Redureau Elise, Bourdin Gaël, Federici Laura, Adda Mélanie, Schnell David, Bousta Mehdi, Salmon-Gandonnière Charlotte, Vanderlinden Thierry, Plantefeve Gaëtan, Delacour David, Delpierre Cyrille, Le Bouar Gurvan, Sedillot Nicholas, Beduneau Gaëtan, Rivière Antoine, Meunier-Beillard Nicolas, Gélinotte Stéphanie, Rigaud Jean-Philippe, Labruyère Marie, Georges Marjolaine, Binquet Christine, Quenot Jean-Pierre
机构信息
Service de Médecine Intensive Réanimation, CH de Dieppe, Dieppe, France.
Centre d'Investigation Clinique, CHU Dijon, Dijon, France.
出版信息
Intensive Care Med. 2023 Oct;49(10):1168-1180. doi: 10.1007/s00134-023-07180-y. Epub 2023 Aug 24.
PURPOSE
Survivors after acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) are at high risk of developing respiratory sequelae and functional impairment. The healthcare crisis caused by the pandemic hit socially disadvantaged populations. We aimed to evaluate the influence of socio-economic status on respiratory sequelae after COVID-19 ARDS.
METHODS
We carried out a prospective multicenter study in 30 French intensive care units (ICUs), where ARDS survivors were pre-enrolled if they fulfilled the Berlin ARDS criteria. For patients receiving high flow oxygen therapy, a flow ≥ 50 l/min and an FiO ≥ 50% were required for enrollment. Socio-economic deprivation was defined by an EPICES (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé - Evaluation of Deprivation and Inequalities in Health Examination Centres) score ≥ 30.17 and patients were included if they performed the 6-month evaluation. The primary outcome was respiratory sequelae 6 months after ICU discharge, defined by at least one of the following criteria: forced vital capacity < 80% of theoretical value, diffusing capacity of the lung for carbon monoxide < 80% of theoretical value, oxygen desaturation during a 6-min walk test and fibrotic-like findings on chest computed tomography.
RESULTS
Among 401 analyzable patients, 160 (40%) were socio-economically deprived and 241 (60%) non-deprived; 319 (80%) patients had respiratory sequelae 6 months after ICU discharge (81% vs 78%, deprived vs non-deprived, respectively). No significant effect of socio-economic status was identified on lung sequelae (odds ratio (OR), 1.19 [95% confidence interval (CI), 0.72-1.97]), even after adjustment for age, sex, most invasive respiratory support, obesity, most severe P/F ratio (adjusted OR, 1.02 [95% CI 0.57-1.83]).
CONCLUSIONS
In COVID-19 ARDS survivors, socio-economic status had no significant influence on respiratory sequelae 6 months after ICU discharge.
目的
2019冠状病毒病（COVID-19）所致急性呼吸窘迫综合征（ARDS）幸存者发生呼吸后遗症和功能障碍的风险很高。这场大流行引发的医疗危机对社会弱势群体造成了冲击。我们旨在评估社会经济状况对COVID-19 ARDS后呼吸后遗症的影响。
方法
我们在法国的30个重症监护病房（ICU）开展了一项前瞻性多中心研究，若ARDS幸存者符合柏林ARDS标准，则预先登记入组。对于接受高流量氧疗的患者，入组要求流量≥50升/分钟且吸入氧分数≥50%。社会经济剥夺由EPICES（健康检查中心的贫困与健康不平等评估）评分≥30.17定义，若患者完成6个月评估则纳入研究。主要结局是ICU出院后6个月的呼吸后遗症，定义为符合以下至少一项标准：用力肺活量<理论值的80%、肺一氧化碳弥散量<理论值的80%、6分钟步行试验期间氧饱和度下降以及胸部计算机断层扫描显示纤维化样表现。
结果
在401例可分析患者中，160例（40%）存在社会经济剥夺，241例（60%）不存在社会经济剥夺；319例（80%）患者在ICU出院后6个月有呼吸后遗症（社会经济剥夺组与非剥夺组分别为81%和78%）。未发现社会经济状况对肺部后遗症有显著影响（优势比（OR）为1.19[95%置信区间（CI）为0.72 - 1.97]），即使在对年龄、性别、最具侵入性的呼吸支持、肥胖、最严重的P/F比值进行调整后也是如此（调整后的OR为1.02[95%CI为0.57 - 1.83]）。
结论
在COVID-19 ARDS幸存者中，社会经济状况对ICU出院后6个月的呼吸后遗症无显著影响。
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