需要机械通气的 COVID-19 感染患者肺纤维化后并发重症肺炎:一项前瞻性多中心研究。

IF 3.6 3区 医学 Q1 RESPIRATORY SYSTEM BMJ Open Respiratory Research Pub Date : 2024-10-04 DOI:10.1136/bmjresp-2024-002538
Junghyun Kim, Ganghee Chae, Won-Young Kim, Chi-Ryang Chung, Young-Jae Cho, Jinwoo Lee, Yangjin Jegal, Joon-Sung Joh, Tae Yun Park, Jung Hwa Hwang, Bo Da Nam, Hee-Young Yoon, Jin Woo Song
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引用次数: 0

摘要

背景:COVID-19 肺炎后肺部并发症,尤其是肺纤维化的处理是 COVID-19 后大流行时代的一个重要问题。我们旨在研究重症 COVID-19 肺炎患者肺纤维化发生的风险因素:我们从韩国 8 家医院招募了 64 名因 COVID-19 肺炎而需要机械通气的患者,对他们的临床和放射学数据进行了前瞻性收集。通过目测评估胸部 CT 上的纤维化变化,并使用自动量化系统测量纤维化程度(混合疾病评分):64 名患者的平均年龄为 58.2 岁(64.1% 为男性)。在胸部 CT 上(中位间隔:入院后 60 天[IQR;41-78 天]),35 名患者(54.7%)出现了≥3 个纤维化病灶。最常见的纤维化病变是牵引性支气管扩张(47 名患者,73.4%)。自动定量测量的纤维化程度中位数为 10.6%(IQR,3.8-40.7%)。在多变量考克斯比例危险模型中,包括九个变量,P 值为 结论:我们的数据表明,男性和女性的肺纤维化程度更高:我们的数据表明,在需要机械通气的重症 COVID-19 肺炎患者中,男性性别和入院时较高的 SOFA 评分与肺纤维化有关。
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Pulmonary fibrosis followed by severe pneumonia in patients with COVID-19 infection requiring mechanical ventilation: a prospective multicentre study.

Backgrounds: The management of lung complications, especially fibrosis, after COVID-19 pneumonia, is an important issue in the COVID-19 post-pandemic era. We aimed to investigate risk factors for pulmonary fibrosis development in patients with severe COVID-19 pneumonia.

Methods: Clinical and radiological data were prospectively collected from 64 patients who required mechanical ventilation due to COVID-19 pneumonia and were enrolled from eight hospitals in South Korea. Fibrotic changes on chest CT were evaluated by visual assessment, and extent of fibrosis (mixed disease score) was measured using automatic quantification system.

Results: 64 patients were enrolled, and their mean age was 58.2 years (64.1% were males). On chest CT (median interval: 60 days [IQR; 41-78 days] from enrolment), 35 (54.7%) patients showed ≥3 fibrotic lesions. The most frequent fibrotic change was traction bronchiectasis (47 patients, 73.4 %). Median extent of fibrosis measured by automatic quantification was 10.6% (IQR, 3.8-40.7%). In a multivariable Cox proportional hazard model, which included nine variables with a p value of <0.10 in an unadjusted analysis as well as age, sex and Body Mass Index, male sex (HR, 3.01; 95% CI, 1.27 to 7.11) and higher initial Sequential Organ Failure Assessment (SOFA) score (HR, 1.18; 95% CI, 1.02 to 1.37) were independently associated with pulmonary fibrosis (≥3 fibrotic lesions).

Conclusion: Our data suggests that male gender and higher SOFA score at intensive care unit admission were associated with pulmonary fibrosis in patients with severe COVID-19 pneumonia requiring mechanical ventilation.

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来源期刊
BMJ Open Respiratory Research
BMJ Open Respiratory Research RESPIRATORY SYSTEM-
CiteScore
6.60
自引率
2.40%
发文量
95
审稿时长
12 weeks
期刊介绍: BMJ Open Respiratory Research is a peer-reviewed, open access journal publishing respiratory and critical care medicine. It is the sister journal to Thorax and co-owned by the British Thoracic Society and BMJ. The journal focuses on robustness of methodology and scientific rigour with less emphasis on novelty or perceived impact. BMJ Open Respiratory Research operates a rapid review process, with continuous publication online, ensuring timely, up-to-date research is available worldwide. The journal publishes review articles and all research study types: Basic science including laboratory based experiments and animal models, Pilot studies or proof of concept, Observational studies, Study protocols, Registries, Clinical trials from phase I to multicentre randomised clinical trials, Systematic reviews and meta-analyses.
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