新冠住院患者长期功能能力下降及生活质量降低
Long-term reduced functional capacity and quality of life in hospitalized COVID-19 patients.
作者信息
da Silveira Anderson Donelli, Scolari Fernando Luis, Saadi Marina Petersen, Brahmbhatt Darshan H, Milani Mauricio, Milani Juliana Goulart Prata Oliveira, Junior Gerson Cipriano, Sartor Ivaine Tais Sauthier, Zavaglia Gabriela Oliveira, Tonini Maiko Luis, da Costa Marcela Santos Correa, Scotta Marcelo Comerlato, Stein Renato T, Rosa Regis Goulart
机构信息
Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Rio de Janeiro, Brazil.
出版信息
Front Med (Lausanne). 2024 Mar 6;10:1289454. doi: 10.3389/fmed.2023.1289454. eCollection 2023.
BACKGROUND
Persistent symptoms and exercise intolerance have been reported after COVID-19, even months after the acute disease. Although, the long-term impact on exercise capacity and health-related quality of life (HRQoL) is still unclear.
RESEARCH QUESTION
To assess the long-term functional capacity and HRQoL in patients hospitalized due to COVID-19.
STUDY DESIGN AND METHODS
This is a prospective cohort study, conducted at two centers in Brazil, that included post-discharge COVID-19 patients and paired controls. The cohort was paired by age, sex, body mass index and comorbidities, using propensity score matching in a 1:3 ratio. Patients were eligible if signs or symptoms suggestive of COVID-19 and pulmonary involvement on chest computed tomography. All patients underwent cardiopulmonary exercise testing (CPET) and a HRQoL questionnaire (SF-36) 6 months after the COVID-19. The main outcome was the percentage of predicted peak oxygen consumption (ppVO2). Secondary outcomes included other CPET measures and HRQoL.
RESULTS
The study sample comprised 47 post-discharge COVID-19 patients and 141 healthy controls. The mean age of COVID-19 patients was 54 ± 14 years, with 19 (40%) females, and a mean body mass index of 31 kg/m (SD, 6). The median follow-up was 7 months (IQR, 6.5-8.0) after hospital discharge. PpVO2 in COVID-19 patients was lower than in controls (83% vs. 95%, = 0.002) with an effect size of 0.38 ([95%CI], 0.04-0.70). Mean peak VO2 (22 vs. 25 mL/kg/min, = 0.04) and OUES (2,122 vs. 2,380, = 0.027) were also reduced in the COVID-19 patients in comparison to controls. Dysfunctional breathing (DB) was present in 51%. HRQoL was significantly reduced in post COVID patients and positively correlated to peak exercise capacity.
INTERPRETATION
Hospitalized COVID-19 patients presented, 7 months after discharge, with a reduction in functional capacity and HRQoL when compared to historical controls. HRQoL were reduced and correlated with the reduced peak VO2 in our population.
背景
新型冠状病毒肺炎（COVID-19）康复后，即使在急性病数月后，仍有持续症状和运动不耐受的报告。然而，其对运动能力和健康相关生活质量（HRQoL）的长期影响仍不明确。
研究问题
评估因COVID-19住院患者的长期功能能力和HRQoL。
研究设计与方法
这是一项前瞻性队列研究，在巴西的两个中心进行，纳入了出院后的COVID-19患者及配对对照。通过倾向得分匹配，按照1:3的比例，根据年龄、性别、体重指数和合并症对队列进行配对。若胸部计算机断层扫描显示有提示COVID-19及肺部受累的体征或症状，则患者符合入选标准。所有患者在COVID-19感染6个月后均接受了心肺运动试验（CPET）和HRQoL问卷调查（SF-36）。主要结局指标是预测的峰值摄氧量百分比（ppVO2）。次要结局指标包括其他CPET测量指标和HRQoL。
结果
研究样本包括47例出院后的COVID-19患者和141例健康对照。COVID-19患者的平均年龄为54±14岁，其中19例（40%）为女性，平均体重指数为31kg/m²（标准差为6）。出院后的中位随访时间为7个月（四分位间距为6.5 - 8.0）。COVID-19患者的ppVO2低于对照组（83%对95%，P = 0.002），效应大小为0.38（[95%置信区间]，0.04 - 0.70）。与对照组相比，COVID-19患者的平均峰值VO2（22对25mL/kg/min，P = 0.04）和氧摄取效率斜率（OUES）（2122对2380，P = 0.027）也有所降低。51%的患者存在功能失调性呼吸（DB）。COVID-19康复患者的HRQoL显著降低，且与峰值运动能力呈正相关。
解读
与历史对照相比，出院7个月后的COVID-19住院患者的功能能力和HRQoL有所下降。在我们的研究人群中，HRQoL降低且与峰值VO2降低相关。
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