COVID-19 住院后 12 个月的神经恢复轨迹：一项前瞻性纵向研究。
Trajectories of Neurologic Recovery 12 Months After Hospitalization for COVID-19: A Prospective Longitudinal Study.
机构信息
From the Department of Neurology (J.A.F., C.M., S.B., K.B., L.B., D.B., S.B., A.C., L.D., B.F., G.G., L.H., J. Horng, R.J., Y.J., D.E.K., E.K., J.L., S.L., A.O., J.R., T.S., D.T., B.T., E.V., T.Z., Y.Z., A.L., A.S.L., K.M., S.T., L.J.B., T.W., S.G.), New York University Grossman School of Medicine; Department of Neurology (D.Y.), New York Presbyterian, Columbia Medical Center, New York; Medical Informatics (J. Huang), NYU Langone Hospitals, New York, NY; Department of Neurology (R.S.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Population Health (S.B.M., A.B.T.), New York University, New York; and Department of Neurology (S.Y.), Brown University School of Medicine, Providence, RI.
出版信息
Neurology. 2022 Jul 5;99(1):e33-e45. doi: 10.1212/WNL.0000000000200356. Epub 2022 Mar 21.
BACKGROUND AND OBJECTIVE
Little is known about trajectories of recovery 12 months after hospitalization for severe COVID-19.
METHODS
We conducted a prospective, longitudinal cohort study of patients with and without neurologic complications during index hospitalization for COVID-19 from March 10, 2020, to May 20, 2020. Phone follow-up batteries were performed at 6 and 12 months after COVID-19 onset. The primary 12-month outcome was the modified Rankin Scale (mRS) score comparing patients with or without neurologic complications using multivariable ordinal analysis. Secondary outcomes included activities of daily living (Barthel Index), telephone Montreal Cognitive Assessment (t-MoCA), and Quality of Life in Neurologic Disorders (Neuro-QoL) batteries for anxiety, depression, fatigue, and sleep. Changes in outcome scores from 6 to 12 months were compared using nonparametric paired-samples sign test.
RESULTS
Twelve-month follow-up was completed in 242 patients (median age 65 years, 64% male, 34% intubated during hospitalization) and 174 completed both 6- and 12-month follow-up. At 12 months, 197/227 (87%) had ≥1 abnormal metric: mRS >0 (75%), Barthel Index <100 (64%), t-MoCA ≤18 (50%), high anxiety (7%), depression (4%), fatigue (9%), or poor sleep (10%). Twelve-month mRS scores did not differ significantly among those with (n = 113) or without (n = 129) neurologic complications during hospitalization after adjusting for age, sex, race, pre-COVID-19 mRS, and intubation status (adjusted OR 1.4, 95% CI 0.8-2.5), although those with neurologic complications had higher fatigue scores (T score 47 vs 44; = 0.037). Significant improvements in outcome trajectories from 6 to 12 months were observed in t-MoCA scores (56% improved, median difference 1 point; = 0.002) and Neuro-QoL anxiety scores (45% improved; = 0.003). Nonsignificant improvements occurred in fatigue, sleep, and depression scores in 48%, 48%, and 38% of patients, respectively. Barthel Index and mRS scores remained unchanged between 6 and 12 months in >50% of patients.
DISCUSSION
At 12 months after hospitalization for severe COVID-19, 87% of patients had ongoing abnormalities in functional, cognitive, or Neuro-QoL metrics and abnormal cognition persisted in 50% of patients without a history of dementia/cognitive abnormality. Only fatigue severity differed significantly between patients with or without neurologic complications during index hospitalization. However, significant improvements in cognitive (t-MoCA) and anxiety (Neuro-QoL) scores occurred in 56% and 45% of patients, respectively, between 6 and 12 months. These results may not be generalizable to those with mild or moderate COVID-19.
背景与目的
对于因严重 COVID-19 而住院后 12 个月的恢复轨迹，我们知之甚少。
方法
我们对 2020 年 3 月 10 日至 5 月 20 日期间因 COVID-19 住院且存在或不伴有神经系统并发症的患者进行了前瞻性、纵向队列研究。在 COVID-19 发病后 6 个月和 12 个月进行电话随访电池检测。主要 12 个月结局是使用多变量有序分析比较有或无神经系统并发症患者的改良 Rankin 量表（mRS）评分。次要结局包括日常生活活动（巴氏指数）、电话蒙特利尔认知评估（t-MoCA）和神经疾病生活质量量表（Neuro-QoL）的焦虑、抑郁、疲劳和睡眠电池检测。使用非参数配对样本符号检验比较 6 个月至 12 个月间的结局评分变化。
结果
242 例患者（中位年龄 65 岁，64%为男性，34%在住院期间插管）完成了 12 个月的随访，174 例患者完成了 6 个月和 12 个月的随访。12 个月时，197/227（87%）存在≥1 项异常指标：mRS>0（75%）、巴氏指数<100（64%）、t-MoCA≤18（50%）、高焦虑（7%）、抑郁（4%）、疲劳（9%）或睡眠不佳（10%）。在校正年龄、性别、种族、COVID-19 发病前 mRS 和插管状态后，住院期间有或无神经系统并发症的患者在 12 个月时的 mRS 评分无显著差异（调整后的 OR 1.4，95%CI 0.8-2.5），尽管有神经系统并发症的患者的疲劳评分更高（T 评分 47 与 44； = 0.037）。从 6 个月到 12 个月，t-MoCA 评分（56%改善，中位数差异 1 分； = 0.002）和 Neuro-QoL 焦虑评分（45%改善； = 0.003）的结局轨迹显著改善。48%、48%和 38%的患者分别出现疲劳、睡眠和抑郁评分的非显著改善。在超过 50%的患者中，6 个月至 12 个月之间巴氏指数和 mRS 评分保持不变。
讨论
在因严重 COVID-19 而住院后 12 个月，87%的患者在功能、认知或 Neuro-QoL 指标上仍存在异常，并且在没有痴呆/认知异常病史的患者中，认知异常持续存在于 50%的患者中。仅在指数住院期间有或无神经系统并发症的患者之间，疲劳严重程度存在显著差异。然而，在 6 个月至 12 个月之间，分别有 56%和 45%的患者的认知（t-MoCA）和焦虑（Neuro-QoL）评分显著改善。这些结果可能不适用于患有轻度或中度 COVID-19 的患者。
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