未经证实:与COVID-19急性期后出现的长期后遗症(所谓的“长COVID”)相关的因素尚不清楚。这里,我们的目的是在因SARS-CoV-2感染住院并出院后1年随访的前瞻性队列中,确定COVID-19后遗症发生的危险因素.
未经评估:在COVID-19出院一年后,共有324名受试者接受了全面和多学科的评估。对同意捐献血液样品的247/324的亚组进行了一组循环细胞因子的测试。
UNASSIGNED:在122名患者(37.8%)中,有证据表明至少有一种持续的身体症状。纠正合并症和COVID-19严重程度后,在第三波大流行期间住院的109名受试者中,发生长期COVID的风险低于第一波期间入院的215名受试者,(OR0.69,95CI0.51-0.93,p=0.01)。单变量分析显示女性性别,肺对一氧化碳(DLCO)值的扩散能力,身体质量指数,焦虑和抑郁症状在1年时与COVID-19后遗症呈正相关。在逻辑回归分析后,DLCO是残留症状的唯一独立预测因子(OR0.98CI95%(0.96-0.99),p=0.01)。在DLCO正常(>80%)的受试者亚组中,对于那些残留的肺损伤是长期COVID的不太可能的解释,焦虑和抑郁症状的存在与持续症状显着相关,加上一组促炎细胞因子的水平增加:干扰素-γ,肿瘤坏死因子-α,白细胞介素(IL)-2,IL-12,IL-1β,IL-17.在逻辑回归分析中,出院1年后抑郁症状(p=0.02,OR4.57[1.21-17.21])和IL-12水平(p=0.03,OR1.06[1.00-1.11])与症状持续独立相关.
未经证实:长型COVID主要表现为呼吸道后遗症,在第一波大流行期间普遍观察到。在很少或没有残留肺损伤的患者中,与全身性炎症一致的细胞因子模式已经到位。
Factors associated with long-term sequelae emerging after the acute phase of COVID-19 (so called \"long COVID\") are unclear. Here, we aimed to identify risk factors for the development of COVID-19 sequelae in a prospective cohort of subjects hospitalized for SARS-CoV-2 infection and followed up one year after discharge.
A total of 324 subjects underwent a comprehensive and multidisciplinary evaluation one year after hospital discharge for COVID-19. A subgroup of 247/324 who consented to donate a blood sample were tested for a panel of circulating cytokines.
In 122 patients (37.8%) there was evidence of at least one persisting physical symptom. After correcting for comorbidities and COVID-19 severity, the risk of developing long COVID was lower in the 109 subjects admitted to the hospital in the third wave of the pandemic than in the 215 admitted during the first wave, (OR 0.69, 95%CI 0.51-0.93, p=0.01). Univariable analysis revealed female sex, diffusing capacity of the lungs for carbon monoxide (
DLCO) value, body mass index, anxiety and depressive symptoms to be positively associated with COVID-19 sequelae at 1 year. Following logistic regression analysis,
DLCO was the only independent predictor of residual symptoms (OR 0.98 CI 95% (0.96-0.99), p=0.01). In the subgroup of subjects with normal
DLCO (> 80%), for whom residual lung damage was an unlikely explanation for long COVID, the presence of anxiety and depressive symptoms was significantly associated to persistent symptoms, together with increased levels of a set of pro-inflammatory cytokines: interferon-gamma, tumor necrosis factor-alpha, interleukin (IL)-2, IL-12, IL-1β, IL-17. In logistic regression analysis, depressive symptoms (p=0.02, OR 4.57 [1.21-17.21]) and IL-12 levels (p=0.03, OR 1.06 [1.00-1.11]) 1-year after hospital discharge were independently associated with persistence of symptoms.
Long COVID appears mainly related to respiratory sequelae, prevalently observed during the first pandemic wave. Among patients with little or no residual lung damage, a cytokine pattern consistent with systemic inflammation is in place.