预测 COVID-19 肺炎幸存者肺弥散能力受损的情况。

IF 2.1 3区 医学 Q3 RESPIRATORY SYSTEM
Journal of thoracic disease Pub Date : 2024-11-30 Epub Date: 2024-11-18 DOI:10.21037/jtd-24-1118
Olga I Savushkina, Elena S Muraveva, Irina V Zhitareva, Galina V Nekludova, Malika Kh Mustafina, Sergey N Avdeev
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引用次数: 0

摘要

背景:据报道,2019 年冠状病毒病(COVID-19)幸存患者会出现肺部后遗症。由于存在感染控制风险,在这种传染病流行期间提供肺功能测试(PFTs)具有挑战性。本研究旨在确定 COVID-19 存活者出院后肺弥散能力受损的重要预测因素:这项回顾性队列研究纳入了 341 名 COVID-19 患者。方法:该回顾性队列研究共纳入了 341 名 COVID-19 患者,评估了肺活量、体温测量、一氧化碳肺弥散容量(DLco)和 COVID-19 急性期最差胸部计算机断层扫描(CTmax,%)的参数。采用多变量逻辑回归分析探索与肺弥散能力受损相关的风险因素。多变量观察的接收者操作特征曲线(ROC)和曲线下面积(AUC)用于评估模型的性能:分析时,64.8%(221/341)的患者参加了 COVID-19 症状出现后 90 天的随访,23.5%(80/341)参加了 90-180 天的随访,11.7%(40/341)参加了超过 180 天的随访。CTmax 的中位数为 50%(根据半定量 CT 评分,50% 的肺面积受到病理过程的影响)。异常的 DLco(最大值)和 COVID-19 症状发作与随访 PFT 之间的时间间隔被纳入逻辑回归分析,以探讨 DLco 降低的预测。采用后向逐步回归法剔除不重要的预测因子。结果发现,CTmax 是预测 DLco 受损的重要指标。AUC 值为 0.780 [95% confidential interval (CI):0.723-0.837,Pmax =45% 及以上在 COVID-19 急性期与 COVID-19 后 6 个月的 DLco 降低显著相关(OR 1.21,95% CI:1.095-1.334;PConclusions:严重急性呼吸系统综合征相关冠状病毒 2(SARS-CoV-2)造成的肺间质损伤肯定会导致出院后 DLco 的降低。这表明,分析 COVID-19 急性期的 CT 扫描结果可能与 DLco 异常的预后相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prediction of impaired lung diffusion capacity in COVID-19 pneumonia survivors.

Background: Patients surviving the coronavirus disease 2019 (COVID-19) are reported to explore pulmonary sequelae. It is challenging to provide pulmonary function tests (PFTs) during the pandemic of this contagious diseases because of the difficulty related to infection control risks. This study aims to identify important predictors of lung diffusion capacity impairment in COVID-19 survivors after hospital discharge.

Methods: The retrospective cohort study included 341 patients after COVID-19. The parameters of spirometry, body plethysmography, lung diffusion capacity for carbon monoxide (DLco), and the worst chest computed tomography (CT) scan in the acute phase of COVID-19 (CTmax, %) were assessed. Multivariable logistic regression analysis for exploring risk factors associated with lung diffusion capacity impairment was used. The receiver operating characteristic (ROC) curve of multivariate observation and the area under the curve (AUC) were used to assess the performance of a model.

Results: At the time of the analysis, 64.8% (221/341) patients participated in follow-up visits on 90 days, 23.5% (80/341) on 90-180 days, and 11.7% (40/341) on more than 180 days after the onset of COVID-19 symptoms. The median CTmax was 50% (50% of the lung area was involved in a pathological process according to a semi-quantitative CT score). Abnormal DLco (<80% of predicted) was recorded in 60.4% cases. The predictors such as age, gender, body mass index (BMI), CTmax, and the time interval between the COVID-19 symptoms onset and follow-up PFTs were encapsulated in the logistic regression analysis to explore the prediction of reduced DLco. Backward stepwise regression was applied to eliminate insignificant predictors. It was found that CTmax was important predictor of impaired DLco. AUC value was 0.780 [95% confidential interval (CI): 0.723-0.837, P<0.001]. The sensitivity and specificity in the training group were 80% and 67%, respectively. The odds ratio (OR) showed that CTmax =45% and more in the acute phase of COVID-19 was significantly associated with reduced DLco during 6 months after COVID-19 (OR 1.21, 95% CI: 1.095-1.334; P<0.05).

Conclusions: Pulmonary interstitial damage caused by severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) definitely contributes to reduced DLco after hospital discharge. This indicates that analysis of CT scans during the acute phase of COVID-19 may have prognostic relevance for abnormal DLco.

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来源期刊
Journal of thoracic disease
Journal of thoracic disease RESPIRATORY SYSTEM-
CiteScore
4.60
自引率
4.00%
发文量
254
期刊介绍: The Journal of Thoracic Disease (JTD, J Thorac Dis, pISSN: 2072-1439; eISSN: 2077-6624) was founded in Dec 2009, and indexed in PubMed in Dec 2011 and Science Citation Index SCI in Feb 2013. It is published quarterly (Dec 2009- Dec 2011), bimonthly (Jan 2012 - Dec 2013), monthly (Jan. 2014-) and openly distributed worldwide. JTD received its impact factor of 2.365 for the year 2016. JTD publishes manuscripts that describe new findings and provide current, practical information on the diagnosis and treatment of conditions related to thoracic disease. All the submission and reviewing are conducted electronically so that rapid review is assured.
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