新冠后遗症：一个全球性的健康问题——一项横跨四大洲的前瞻性队列研究

21 October 2024


Ekaterina Pazukhina, Esteban Garcia-Gallo, Luis Felipe Reyes, Anders Benjamin Kildal, Waasila Jassat, Murray Dryden, Jan Cato Holter, Allegra Chatterjee, Kyle Gomez, Arne Søraas, Matteo Puntoni, Nicola Latronico, Fernando A Bozza, Michael Edelstein, Bronner P Gonçalves, Christiana Kartsonaki, Oksana Kruglova, Sérgio Gaião, Yock Ping Chow, Yash Doshi, Sara Isabel Duque Vallejo, Elsa D Ibáñez-Prada, Yuli V Fuentes, Claire Hastie, Margaret E O'Hara, Valeria Balan, Tigist Menkir, Laura Merson, Sadie Kelly, Barbara Wanjiru Citarella, Malcolm G Semple, Janet T Scott, Daniel Munblit, Louise Sigfrid; ISARIC Clinical Characterisation Group and ISARIC Global Covid-19 follow up working group

在此查看研究
复制引用
已复制！

摘要

Introduction

A proportion of people develop Long Covid after acute COVID-19, but with most studies concentrated in high-income countries (HICs), the global burden is largely unknown. Our study aims to characterise long-term COVID-19 sequelae in populations globally and compare the prevalence of reported symptoms in HICs and low-income and middle-income countries (LMICs).

Methods

A prospective, observational study in 17 countries in Africa, Asia, Europe and South America, including adults with confirmed COVID-19 assessed at 2 to <6 and 6 to <12 months post-hospital discharge. A standardised case report form developed by International Severe Acute Respiratory and emerging Infection Consortium's Global COVID-19 Follow-up working group evaluated the frequency of fever, persistent symptoms, breathlessness (MRC dyspnoea scale), fatigue and impact on daily activities.

Results

Of 11 860 participants (median age: 52 (IQR: 41-62) years; 52.1% females), 56.5% were from HICs and 43.5% were from LMICs. The proportion identified with Long Covid was significantly higher in HICs vs LMICs at both assessment time points (69.0% vs 45.3%, p<0.001; 69.7% vs 42.4%, p<0.001). Participants in HICs were more likely to report not feeling fully recovered (54.3% vs 18.0%, p<0.001; 56.8% vs 40.1%, p<0.001), fatigue (42.9% vs 27.9%, p<0.001; 41.6% vs 27.9%, p<0.001), new/persistent fever (19.6% vs 2.1%, p<0.001; 20.3% vs 2.0%, p<0.001) and have a higher prevalence of anxiety/depression and impact on usual activities compared with participants in LMICs at 2 to <6 and 6 to <12 months post-COVID-19 hospital discharge, respectively.

Conclusion

Our data show that Long Covid affects populations globally, manifesting similar symptomatology and impact on functioning in both HIC and LMICs. The prevalence was higher in HICs versus LMICs. Although we identified a lower prevalence, the impact of Long Covid may be greater in LMICs if there is a lack of support systems available in HICs. Further research into the aetiology of Long Covid and the burden in LMICs is critical to implement effective, accessible treatment and support strategies to improve COVID-19 outcomes for all.

参考资料

  1. Khetan, A. K., Yusuf, S., Lopez-Jaramillo, P., Dagenais, G., Rosengren, A., Lanas, F., Lear, S. A., Rangarajan, S., & Islam, S. (2022). Variations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis. EClinicalMedicine, 44, Article 101284. https://doi.org/10.1016/j.eclinm.2022.101284
  2. Josephson, A., Kilic, T., & Michler, J. D. (2021). Socioeconomic impacts of COVID-19 in low-income countries. Nature Human Behaviour, 5(5), 557–565. https://doi.org/10.1038/s41562-021-01096-7
  3. World Health Organization. (2023). WHO coronavirus (COVID-19) dashboard. World Health Organization. https://covid19.who.int
  4. Choutka, J., Jansari, V., Hornig, M., & Iwasaki, A. (2022). Unexplained post-acute infection syndromes. Nature Medicine, 28(5), 911–923. https://doi.org/10.1038/s41591-022-01810-6
  5. Narasimhan, H., Wu, Y., Goplen, N. P., & et al. (2022). Immune determinants of chronic sequelae after respiratory viral infection. Science Immunology, 7(73), Article labm7996. https://doi.org/10.1126/sciimmunol.abm7996
  6. Restrepo, M. I., & Reyes, L. F. (2018). Pneumonia as a cardiovascular disease. Respirology, 23(3), 250–259. https://doi.org/10.1111/resp.13233
  7. Reyes, L. F., Restrepo, M. I., Hinojosa, C. A., Soni, N. J., Anzueto, A., Babu, B. L., Gonzalez-Juarbe, N., Rodriguez, A. H., Chalmers, J. D., Aliberti, S., Sibila, O., Rello, J., Waterer, G. W., & Orihuela, C. J. (2017). Severe pneumococcal pneumonia causes acute cardiac toxicity and subsequent cardiac remodeling. American Journal of Respiratory and Critical Care Medicine, 196(5), 609–620. https://doi.org/10.1164/rccm.201701-0104OC
  8. Restrepo, M. I., Reyes, L. F., & Anzueto, A. (2016). Complication of community-acquired pneumonia (including cardiac complications). Seminars in Respiratory and Critical Care Medicine, 37(6), 897–904. https://doi.org/10.1055/s-0036-1593754
  9. World Health Organization. (2021). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. World Health Organization. https://www.who.int/publications/i/item/WHO-2019-nCoV-Post_COVID-19_condition-Clinical_case_definition-2021.1
  10. Huang, C., Huang, L., Wang, Y., Li, X., Ren, L., Gu, X., Kang, L., Guo, L., Liu, M., Zhou, X., Luo, J., Huang, Z., Tu, S., Zhao, Y., Chen, L., Xu, D., Li, Y., Li, C., Peng, L., ... & Wang, J. (2021). 6-month consequences of COVID-19 in patients discharged from hospital: A cohort study. The Lancet, 397(10270), 220–232. https://doi.org/10.1016/S0140-6736(20)32656-8
  11. Hastie, C. E., Lowe, D. J., McAuley, A., Winter, A. J., Mills, N. T., McAslan, H., Luck, E., Henderson, M., King, A., Brooke, R. J., Agrawal, U., Shah, A. A., Murray, J. L. K., & Pell, J. P. (2023). True prevalence of long-COVID in a nationwide, population cohort study. Nature Communications, 14(1), Article 7892. https://doi.org/10.1038/s41467-023-43661-w
  12. Zheng, B., Vivaldi, G., Daines, L., Leavy, O. C., Richardson, M., Elneima, O., McAuley, H. J. C., Shikotra, A., Singapuri, A., Sereno, M., Saunders, R. M., Harris, V. C., Houchen-Wolloff, L., Greening, N. J., Brown, J. S., Joshi, I., Montgomery, H., Poinasamy, K., Marks, M., ... & Evans, R. A. (2023). Determinants of recovery from post-COVID-19 dyspnoea: Analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls. The Lancet Regional Health – Europe, 29, Article 100635. https://doi.org/10.1016/j.lanepe.2023.100635
  13. Byambasuren, O., Stehlik, P., Clark, J., Alcorn, K., & Glasziou, P. (2023). Effect of COVID-19 vaccination on long covid: Systematic review. BMJ Medicine, 2(1), Article e000385. https://doi.org/10.1136/bmjmed-2022-000385
  14. Gao, P., Liu, J., Liu, M., & et al. (2022). Effect of COVID-19 vaccines on reducing the risk of Long COVID in the real world: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(19), Article 12422. https://doi.org/10.3390/ijerph191912422
  15. Michelen, M., Manoharan, L., Elkheir, N., Cheng, V., Dagens, A., Hastie, C., O'Hara, M., Suett, J., Bain, D., Groce, N., Merson, L., Carson, G., Citarella, B. W., & Sigfrid, L. (2021). Characterising long COVID: A living systematic review. BMJ Global Health, 6(9), Article e005427. https://doi.org/10.1136/bmjgh-2021-005427
  16. Chippa, V., Aleem, A., & Anjum, F. (2023). Post-acute coronavirus (COVID-19) syndrome. StatPearls Publishing.
  17. Munblit, D., O’Hara, M. E., Akrami, A., Perego, E., Olliaro, P., & Needham, D. M. (2022). Long COVID: Aiming for a consensus. The Lancet Respiratory Medicine, 10(7), 632–634. https://doi.org/10.1016/S2213-2600(22)00135-7
  18. Jassat, W., Reyes, L. F., Munblit, D., & et al. (2023). Long COVID in low-income and middle-income countries: The hidden public health crisis. The Lancet, 402(10408), 1115–1117. https://doi.org/10.1016/S0140-6736(23)01685-9
  19. Reyes, L. F., Murthy, S., Garcia-Gallo, E., & et al. (2022). Clinical characteristics, risk factors and outcomes in patients with severe COVID-19 registered in the International Severe Acute Respiratory and Emerging Infection Consortium WHO clinical characterisation protocol: A prospective, multinational, multicentre, observational study. ERJ Open Research, 8(1), Article 00552-2021. https://doi.org/10.1183/23120541.00552-2021
  20. Hall, M. D., Baruch, J., Carson, G., & et al. (2021). Ten months of temporal variation in the clinical journey of hospitalised patients with COVID-19: An observational cohort. eLife, 10, Article e70970. https://doi.org/10.7554/eLife.70970
  21. Carson, G., & Long Covid Forum Group. (2021). Research priorities for Long Covid: Refined through an international multi-stakeholder forum. BMC Medicine, 19(1), Article 84. https://doi.org/10.1186/s12916-021-01947-0
  22. Sigfrid, L., Cevik, M., Jesudason, E., & et al. (2021). What is the recovery rate and risk of long-term consequences following a diagnosis of COVID-19? A harmonised, global longitudinal observational study protocol. BMJ Open, 11(3), Article e043887. https://doi.org/10.1136/bmjopen-2020-043887
  23. Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
  24. Abbas, A., Abdukahil, S. A., Abdulkadir, N. N., & et al. (2022). ISARIC-COVID-19 dataset: A prospective, standardized, global dataset of patients hospitalized with COVID-19. Scientific Data, 9(1), Article 454. https://doi.org/10.1038/s41597-022-01534-9
  25. Griffee, M. J., Bozza, P. T., Reyes, L. F., & et al. (2023). Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry. Research and Practice in Thrombosis and Haemostasis, 7(5), Article 102142. https://doi.org/10.1016/j.rpth.2023.102142
  26. Reyes, L. F., Garcia-Gallo, E., Murthy, S., & et al. (2022). Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: A prospective, multinational, observational study. Critical Care, 26(1), Article 276. https://doi.org/10.1186/s13054-022-04155-1
  27. Reyes, L. F., Garcia-Gallo, E., Murthy, S., & et al. (2023). Major adverse cardiovascular events (MACE) in patients with severe COVID-19 registered in the ISARIC WHO clinical characterization protocol: A prospective, multinational, observational study. Journal of Critical Care, 77, Article 154318. https://doi.org/10.1016/j.jcrc.2023.154318
  28. World Health Organization. (2022). Post COVID-19 condition (Long COVID). World Health Organization. https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-post-covid-19-condition
  29. World Bank. (2024). World Bank country and lending groups. The World Bank Group. https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups
  30. Hernández-Aceituno, A., García-Hernández, A., Larumbe-Zabala, E., & et al. (2023). COVID-19 long-term sequelae: Omicron versus Alpha and Delta variants. Infectious Diseases Now, 53(5), Article 104688. https://doi.org/10.1016/j.idnow.2023.104688
  31. Jassat, W., Mudara, C., Vika, C., & et al. (2023). A cohort study of post-COVID-19 condition across the Beta, Delta, and Omicron waves in South Africa: 6-month follow-up of hospitalized and nonhospitalized participants. International Journal of Infectious Diseases, 128, 102–111. https://doi.org/10.1016/j.ijid.2022.12.036
  32. Piva, S., Pozzi, M., Bellani, G., & et al. (2023). Long-term physical impairments in survivors of COVID-19-associated ARDS compared with classic ARDS: A two-center study. Journal of Critical Care, 76, Article 154285. https://doi.org/10.1016/j.jcrc.2023.154285
  33. Latronico, N., Peli, E., Calza, S., & et al. (2022). Physical, cognitive and mental health outcomes in 1-year survivors of COVID-19-associated ARDS. Thorax, 77(3), 300–303. https://doi.org/10.1136/thoraxjnl-2021-218064
  34. Gorst, S. L., Seylanova, N., Dodd, S. R., & et al. (2023). Core outcome measurement instruments for use in clinical and research settings for adults with post-COVID-19 condition: An international Delphi consensus study. The Lancet Respiratory Medicine, 11(12), 1101–1114. https://doi.org/10.1016/S2213-2600(23)00370-3
  35. Davis, H. E., McCorkell, L., Vogel, J. M., & Topol, E. J. (2023). Long COVID: Major findings, mechanisms and recommendations. Nature Reviews Microbiology, 21(3), 133–146. https://doi.org/10.1038/s41579-022-00846-2
  36. Altmann, D. M., Whettlock, E. M., Liu, S., & et al. (2023). Author Correction: The immunology of long COVID. Nature Reviews Immunology, 23(10), 697. https://doi.org/10.1038/s41577-023-00948-9
  37. Bucher, A., Antonio, E., Jabin, N., & et al. (2020). A living mapping review for COVID-19 funded research projects: Final (27 month) update. Wellcome Open Research, 5, Article 209. https://doi.org/10.12688/wellcomeopenres.16259.10

引用

Pazukhina E, Garcia-Gallo E, Reyes LF, Kildal AB, Jassat W, Dryden M, et al. Long Covid: a global health issue – a prospective, cohort study set in four continents. BMJ Global Health. 2024;9:e015245. https://doi.org/10.1136/bmjgh-2024-015245

复制引用 已复制！
在此查看研究