背景:感染SARS-CoV-2的住院患者应在几周内康复。然而,即使是轻度版本的人也会出现持续4周或更长时间的症状。这些后COVID-19条件(PCC)包括各种新的,返回,或持续的症状可能持续数月或数年并导致残疾。很少有研究使用感染SARS-CoV-2的出院患者的自我报告来调查PCC,以补充临床和生物标志物研究。
目的:本研究旨在调查自我报告,在COVID-19大流行的第二波和第三波期间出院的SARS-CoV-2感染患者中持续的PCC。
方法:我们设计,预先测试,并向2020年10月至2021年4月期间出院的所有符合条件的住院患者发布了一份临时纸质问卷。出院后4个月,我们收集了有关PCC的数据和多维疲劳清单(MFI)的得分,患者健康问卷-4(PHQ-4),简要记忆筛查量表(Q3PC),和创伤后应激障碍量表(PCL-5)。描述性的,推论,和多元线性回归统计评估PCC症状,协会,以及社会人口统计学特征和住院时间(LOS)的差异。我们检查了我们感兴趣的变量是否显着预测MFI得分。
结果:在返回的1993年有效问卷中,245人来自SARS-CoV-2出院患者(中位年龄71,IQR62.7-77岁)。只有28.2%(69/245)的受访者在4个月后无症状。女性的PCC症状持续明显多于男性(P≤0.001)。住院LOS≥11天的患者也有更多的PCC症状(P<.001)-女性症状更多,LOS更长。在年龄组(18-64岁、65-74岁和≥75岁;P=.50)之间或重症监护病房和其他住院病房之间(P=.09)没有发现显着差异。患者住院期间自我报告的PHQ-4评分明显高于4个月后(P<.001)。四分之三(187/245,76.4%)的受访者报告了记忆力减退和注意力集中障碍(Q3PC)。MFI评分中位数(56,IQR1-3,范围50-60]没有显着差异与社会人口统计学变量相关。住院LOS≥11天的患者PCL-5评分中位数明显较高(P<.001)。多元线性回归使我们能够计算出PHQ-4,Q3PC,和PCL-5得分,根据年龄调整,性别,和LOS(≥11天[中位数2症状,IQR1-5]或<11天),没有显著预测MFI评分(R2=0.09;F4,7=1.5;P=.22;调整后的R2=0.06)。
结论:大多数感染SARS-CoV-2的住院患者在出院后4个月出现PCC,复杂的临床图片。在此期间,只有三分之一的人没有症状。根据我们的发现,MFI评分与自我报告的抑郁症没有直接关系,焦虑,或者根据年龄调整后的创伤后评分,性别,或LOS。需要进一步的研究来根据感染SARS-CoV-2的出院住院患者的自我报告的健康经验来探索PCC和疲劳。
BACKGROUND: Hospitalized patients infected with SARS-CoV-2 should recover within a few weeks. However, even those with mild versions can experience symptoms lasting 4 weeks or longer. These post-COVID-19 condition (PCC) comprise various new, returning, or ongoing symptoms that can last for months or years and cause disability. Few studies have investigated PCC using self-reports from discharged patients infected with SARS-CoV-2 to complement clinical and biomarker studies.
OBJECTIVE: This study aimed to investigate self-reported, persistent PCC among patients infected with SARS-CoV-2 who were discharged during the second and third waves of the COVID-19 pandemic.
METHODS: We designed, pretested, and posted an ad hoc paper questionnaire to all eligible inpatients discharged between October 2020 and April 2021. At 4 months post discharge, we collected data on PCC and scores for the Multidimensional Fatigue Inventory (MFI), the Patient Health Questionnaire-4 (PHQ-4), a Brief Memory Screening Scale (Q3PC), and a posttraumatic stress disorder scale (PCL-5). Descriptive, inferential, and multivariate linear regression statistics assessed PCC symptomatology, associations, and differences regarding sociodemographic characteristics and hospital length of stay (LOS). We examined whether our variables of interest significantly predicted MFI scores.
RESULTS: Of the 1993 valid questionnaires returned, 245 were from discharged patients with SARS-CoV-2 (median age 71, IQR 62.7-77 years). Only 28.2% (69/245) of respondents were symptom-free after 4 months. Women had significantly more persistent PCC symptoms than men (P≤.001). Patients with a hospital LOS ≥11 days had more PCC symptoms as well (P<.001)-women had more symptoms and longer LOS. No significant differences were found between age groups (18-64, 65-74, and ≥75 years old; P=.50) or between intensive care units and other hospitalization units (P=.09). Patients self-reported significantly higher PHQ-4 scores during their hospitalization than at 4 months later (P<.001). Three-fourth (187/245, 76.4%) of the respondents reported memory loss and concentration disorders (Q3PC). No significant differences in the median MFI score (56, IQR 1-3, range 50-60]) were associated with sociodemographic variables. Patients with a hospital LOS of ≥11 days had a significantly higher median PCL-5 score (P<.001). Multivariate linear regression allowed us to calculate that the combination of PHQ-4, Q3PC, and PCL-5 scores, adjusted for age, sex, and LOS (of either ≥11 days [median 2 symptoms, IQR 1-5] or <11 days), did not significantly predict MFI scores (R2=0.09; F4,7 =1.5; P=.22; adjusted R2=0.06).
CONCLUSIONS: The majority of inpatients infected with SARS-CoV-2 presented with PCC 4 months after discharge, with complex clinical pictures. Only one-third of them were symptom-free during that time. Based on our findings, MFI scores were not directly related to self-reported depression, anxiety, or posttraumatic scores adjusted for age, sex, or LOS. Further research is needed to explore PCC and fatigue based on self-reported health experiences of discharged inpatients infected with SARS-CoV-2.