Clinica Medica, Department of Clinical and Molecular Sciences, Marche Polytechnic University, 60126 Ancona, Italy.
Internal and Subintensive Medicine, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy.
Medicina (Kaunas). 2023 Aug 31;59(9):1583. doi: 10.3390/medicina59091583.
The post-COVID-19 syndrome is a clinical entity characterized by the manifestation of signs and symptoms that develop after the acute phase of COVID-19, which persist for a duration of more than 12 weeks and are not explained by any alternative diagnosis. It has been observed that individuals with pre-existing chronic diseases, including cardiovascular and pulmonary diseases, are at a greater risk of developing post-COVID-19 syndrome. The Charlson Comorbidity Index (CCI) is a useful tool employed to evaluate the burden of comorbidities and predict the prognosis of patients with post-COVID-19 syndrome. The present study aims to assess whether the burden of comorbidities, evaluated using the CCI, correlates with post-COVID-19 syndrome. Between 21 April 2020 and 15 May 2023, we enrolled all consecutive outpatients with previous COVID-19 admissions to a post-acute day-hospital service three months after a negative SARS-CoV-2 molecular test. We assessed age, sex, BMI, acute COVID-19 and post-COVID-19 signs, and symptoms and calculated CCI according to its current definition. Post-COVID-19 syndrome was defined as the persistence of at least one sign or symptom lasting more than 12 weeks after COVID-19 resolution and not explained by an alternative diagnosis. The relationship between post-COVID-19 and CCI was explored first with the chi-squared test, then with different binary logistic regression models. We considered significant values of lower than 0.05. We obtained a cohort of 3636 patients and observed a significant association between the number of post-COVID-19 symptoms and CCI. Patients developing post-COVID-19 were more commonly affected by a greater burden of comorbidities. Patients with at least one CCI point had an increased risk of post-COVID-19 syndrome (OR:2.961; 95%CI: 2.269-3.863; < 0.0001), which increased further for CCI ≥ 4 (OR:6.062; 95%CI: 3.163-11.618; < 0.0001). Patients affected by post-COVID-19 show a greater clinical complexity and a larger burden of comorbidities, synthesized by a higher CCI; moreover, a higher CCI seems to correlate with an increasing post-COVID-19 risk, being the presence of ≥1 or ≥4 CCI points associated with a 3-fold and 6-fold increased risk of post-COVID-19 syndrome, respectively.
新冠病毒感染后综合征是一种临床实体，其特征为在新冠病毒感染的急性期后出现持续 12 周以上的症状和体征，且无法用其他诊断来解释。已经观察到，患有包括心血管和肺部疾病在内的慢性疾病的个体，患新冠病毒感染后综合征的风险更高。Charlson 合并症指数（CCI）是一种有用的工具，用于评估合并症的负担，并预测新冠病毒感染后综合征患者的预后。本研究旨在评估使用 CCI 评估的合并症负担是否与新冠病毒感染后综合征相关。在 2020 年 4 月 21 日至 2023 年 5 月 15 日期间，我们招募了所有在急性新冠病毒感染后住院的连续门诊患者，这些患者在 SARS-CoV-2 分子检测阴性后三个月接受了急性新冠病毒感染后日间医院服务。我们评估了年龄、性别、BMI、急性新冠病毒感染和新冠病毒感染后出现的症状和体征，并根据其当前定义计算了 CCI。新冠病毒感染后综合征被定义为在新冠病毒感染消退后持续至少 12 周的至少一种症状或体征，且无法用其他诊断来解释。首先用卡方检验探索新冠病毒感染后与 CCI 的关系，然后用不同的二元逻辑回归模型进行探索。我们认为 值小于 0.05 具有统计学意义。我们获得了一组 3636 名患者，观察到新冠病毒感染后出现的症状数量与 CCI 之间存在显著关联。出现新冠病毒感染后综合征的患者通常患有更严重的合并症负担。至少有一个 CCI 点的患者发生新冠病毒感染后综合征的风险增加（OR：2.961；95%CI：2.269-3.863； < 0.0001），CCI ≥ 4 的患者风险进一步增加（OR：6.062；95%CI：3.163-11.618； < 0.0001）。患有新冠病毒感染后综合征的患者表现出更大的临床复杂性和更严重的合并症负担，这由更高的 CCI 综合体现；此外，更高的 CCI 似乎与新冠病毒感染后综合征的风险增加相关，CCI 存在 1 个或 4 个以上点与新冠病毒感染后综合征的风险分别增加 3 倍和 6 倍相关。
