Sintomas Long COVID em Doentes Não Hospitalizados: Um Estudo Retrospetivo
DOI:
https://doi.org/10.20344/amp.19566Palavras-chave:
COVID-19/complicações, Cuidados de Saúde Primários, Síndrome Pós-COVID-19 AgudaResumo
Introdução: A pandemia de COVID-19 trouxe desafios aos serviços de saúde. À medida que o número de indivíduos afetados aumenta, é crucial encontrar abordagens preventivas, diagnósticas e terapêuticas. Este estudo tem como objetivo descrever diferentes sequelas de COVID-19 numa população dos Cuidados de Saúde Primários.
Métodos: Estudo de coorte retrospetivo de indivíduos adultos diagnosticados com COVID-19 entre março 2020 e abril 2022, excluindo grávidas, menores, residentes em Estrutura Residencial para Pessoas Idosas, internados e óbitos. Colheu-se informação através da plataforma Trace COVID-19®, um questionário pré-estabelecido (que incluiu a versão portuguesa do Instrumento Abreviado de Avaliação da Qualidade de Vida da Organização Mundial da Saúde) e, quando necessário, registos clínicos dos utentes. Foi obtida informação sobre as características sociodemográficas e clínicas no momento de infeção aguda juntamente com sintomas de long COVID.
Resultados: Estudaram-se 284 doentes com COVID-19, entre os 19 e os 99 anos. Os cinco sintomas agudos de COVID-19 mais prevalentes foram febre (50,0%), cansaço (48,2%), mialgias (44,7%), tosse seca (37,7%) e odinofagia (36,3%). Os sintomas relacionados ao sistema neurológico (23,2%) e cansaço (22,9%) foram os mais prevalentes na long COVID. Cansaço e artralgia agudos foram associados a todas as situações de long COVID. Associações entre sintomas agudos e sintomas de long COVID foram maiores entre anosmia e capítulo neurológico [OR = 5,07, intervalo de confiança (IC) 95%, 2,49 – 10,36, p < 0,001], cansaço agudo e cansaço prolongado (OR = 4,07, IC 95%, 2,07 – 8,02 p =0,041), fadiga e capítulo músculo/esquelético (OR = 7,55, IC 95%, 3,06 – 18,66, p < 0,001), cansaço e capítulo endócrino/hormonal (OR = 6.54, IC 95%, 2,37 – 18,04, p < 0,001), dispneia e sintomas respiratórios (OR = 5,67 IC 95% 1,92 – 16,74, p = 0,002) e por fim febre e capítulo gastrointestinal (OR = 8,06, IC 95%, 2,55 – 25,47, p < 0,001). Quase todas as dimensões da qualidade de vida foram associadas negativamente ao número de sintomas de long COVID.
Conclusão: Um maior número de sintomas agudos, bem como a presença de sintomas específicos de COVID-19, foram associados a sintomatologia ≥ 12 semanas após a infeção. Na população estudada, um aumento no número de sintomas, quer na COVID aguda quer na long COVID, teve um impacto negativo significativo na perceção da qualidade de vida geral. A identificação dessas relações poderá trazer uma nova perspetiva de cuidados pós-COVID.
Downloads
Referências
Stafie CS, Solomon SM, Sufaru IG, Manaíra M, Stafie I, Melinte G, et al. Pathogenic connections in post-COVID conditions: what do we know in the large unknown? A narrative review. Viruses. 2022;14:1686. DOI: https://doi.org/10.3390/v14081686
World Health Organization. Coronavirus (COVID-19) Dashboard. WHO Coronavirus (COVID-19) Dashboard with vaccination data. [cited 2022 Nov 12]. Available from: https://covid19.who.int/?adgroupsurvey={adgroupsurvey}&gclid=CjwKCAiA7IGcBhA8EiwAFfUDsUmVPO6H6MdGsxoL8lUELV10aUc7aHN8ThMhRbbsmGmPX 9Ld2wdBRBoC-ngQAvD_BwEGitHub - CSSEGISandData/COVID-19: Novel Coronavirus (COVID-19) Cases, provided by JHU CSSE.
Franco JV, Garegnani LI, Oltra GV, Metzendorf M, Trivisonno L, Sgarbossa N, et al. Long-term health symptoms and sequelae following SARS-CoV-2 infection: an evidence map. Int J Environ Res Public Health. 2022;19:9915. DOI: https://doi.org/10.3390/ijerph19169915
Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22:e1027. DOI: https://doi.org/10.1016/S1473-3099(21)00703-9
Serviços Partilhados do Ministério da Saúde. Trace COVID-19: gestão de vigilâncias. Manual de utilizador. Version 1.1. 2020. [cited 2022 Nov 23]. Available from: https://www.arscentro.min-saude.pt/wp-content/uploads/sites/6/2020/05/TraceCOVID-deck-V1.pdf
Michelen M, Manoharan L, Elkheir N, Cheng V, Dagens A, Hastie C, et al. Characterising long COVID: a living systematic review. BMJ Glob Health. 2021;6:e005427. DOI: https://doi.org/10.1136/bmjgh-2021-005427
Nalbandian A, Sehgal K, Gupta A, Madhavan M, McGroder C, Stevens J, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27:601-15. DOI: https://doi.org/10.1038/s41591-021-01283-z
Greenhalgh T, Knight M, A’Court C, Buxton M, Husain L. Management of post- acute covid-19 in primary care. BMJ. 2020;370:m3026. DOI: https://doi.org/10.1136/bmj.m3026
Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220-32. DOI: https://doi.org/10.1016/S0140-6736(20)32656-8
Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A, et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Sci Rep. 2021;11:16144. DOI: https://doi.org/10.1038/s41598-021-95565-8
Rello J, James A, Reyes LF. Post-acute COVID-19 syndrome (PACS): a public health emergency. Anaesth Crit Care Pain Med. 2021;40:100882. DOI: https://doi.org/10.1016/j.accpm.2021.100882
Wong FY, Yang L, Yuen JW, Chang KK, Wong FK. Assessing quality of life using WHOQOL-BREF: a cross-sectional study on the association between quality of life and neighborhood environmental satisfaction, and the mediating effect of health-related behaviors. BMC Public Health. 2018;18:1113. DOI: https://doi.org/10.1186/s12889-018-5942-3
Serra AV, Canavarro MC, Simões MR, Pereira M, Gameiro S, Quartilho MJ, et al. Estudos psicométricos do instrumento avaliação da qualidade de vida da Organização Mundial de Saúde (WHOQOL-Bref) para português de Portugal. Psiquiatria Clínica. 2006;27:41-9.
Nunnally J. Psychometric theory. 2nd ed. New York: McGraw-Hill; 1978.
Gelman A, Hill J. Data analysis using regression and multilevel/hierarchical models. Cambridge: Cambridge University Press; 2006. DOI: https://doi.org/10.1017/CBO9780511790942
Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: a systematic review and meta-analysis. J Infect. 2020;80:656-65. DOI: https://doi.org/10.1016/j.jinf.2020.03.041
Fernández-de-las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Florencio L, Cuadrado M, Plaza-Manzano G, et al. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: a systematic review and meta-analysis. Eur J Intern Med. 2021;92:55-70. DOI: https://doi.org/10.1016/j.ejim.2021.06.009
Talukder A, Razu SR, Alif SM, Rahman MA, Islam SM. Association between symptoms and severity of disease in hospitalised novel coronavirus (COVID- 19) patients: a systematic review and meta-analysis. J Multidiscip Healthc. 2022;15:1101-10. DOI: https://doi.org/10.2147/JMDH.S357867
Munsch N, Gruarin S, Nateqi J, Lutz T, Binder M, Aberle J, et al. Symptoms associated with a COVID-19 infection among a non-hospitalized cohort in Vienna. Wien Klin Wochenschr. 2022;134:344-50. DOI: https://doi.org/10.1007/s00508-022-02028-9
Fernández-de-las-Peñas C, Pellicer-Valero OJ, Navarro-Pardo E, Palacios-Ceña D, Florencio L, Guijarro C, et al. Symptoms experienced at the acute phase of SARS-CoV-2 infection as risk factor of long-term post-COVID symptoms: The LONG-COVID-EXP-CM multicenter study. Int J Infect Dis. 2022;116:241-4. DOI: https://doi.org/10.1016/j.ijid.2022.01.007
Subramanian A, Nirantharakumar K, Hughes S, Myles P, Williams T, Gokhale K, et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med. 2022;28:1706-14. DOI: https://doi.org/10.1038/s41591-022-01909-w
Silva Andrade B, Siqueira S, de Assis Soares WR, de Souza Rangel F, Santos N, dos Santos Freitas A, et al. Long-COVID and post- COVID health complications: an up-to-date review on clinical conditions and their possible molecular mechanisms. Viruses. 2021;13:700. DOI: https://doi.org/10.3390/v13040700
Bell ML, Catalfamo CJ, Farland L, Ernest K, Jacobs E, Klimentidis Y, et al. Post-acute sequelae of COVID-19 in a non-hospitalized cohort: results from the Arizona CoVHORT. PLoS One. 2021;16:e0254347. DOI: https://doi.org/10.1371/journal.pone.0254347
Salari N, Khodayari Y, Hosseinian-Far A, Zarei H, Rasoulpoor S, Akbari H, et al. Global prevalence of chronic fatigue syndrome among long COVID-19 patients: a systematic review and meta- analysis. Biopsychosoc Med. 2022;16:21. DOI: https://doi.org/10.1186/s13030-022-00250-5
Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post- COVID-19 symptom burden: what is long-COVID and how should we manage it? Lung. 2021;199:113-9. DOI: https://doi.org/10.1007/s00408-021-00423-z
van Kessel SA, Olde Hartman TC, Lucassen PL, van Jaarsveld CH. Post- acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review. Fam Pract. 2022;39:159-67. DOI: https://doi.org/10.1093/fampra/cmab076
Pavli A, Theodoridou M, Maltezou HC. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res. 2021;52:575-81. DOI: https://doi.org/10.1016/j.arcmed.2021.03.010
Ayuso García B, Pérez López A, Besteiro Balado Y, Romay Lema E, García País M, Marchán-López Á, et al. Calidad de vida relacionada con la salud en pacientes recuperados de COVID-19. J Healthc Qual Res. 2022;37:208-15. DOI: https://doi.org/10.1016/j.jhqr.2022.01.001
Han Q, Zheng B, Daines L, Sheikh A. Long-term sequelae of COVID-19: a systematic review and meta-analysis of one-year follow-up studies on post-COVID symptoms. Pathogens. 2022;11:269. DOI: https://doi.org/10.3390/pathogens11020269
Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management. BMJ. 2021:n1648. DOI: https://doi.org/10.1136/bmj.n1648
Pérez-González A, Araújo-Ameijeiras A, Fernández-Villar A, Crespo M, Poveda E, Cabrera J, et al. Long COVID in hospitalized and non-hospitalized patients in a large cohort in Northwest Spain, a prospective cohort study. Sci Rep. 2022;12:3369. DOI: https://doi.org/10.1038/s41598-022-18023-z
Choudhury A, Tarij R, Jena A, Vesely E, Singh S, Khanna S, et al. Gastrointestinal manifestations of long COVID: a systematic review and meta-analysis. Therap Adv Gastroenterol. 2022;15:17562848221118403. DOI: https://doi.org/10.1177/17562848221118403
Liu Q, Mak JW, Su Q, Yeoh Y, Lui G, Ng S, et al. Gut microbiota dynamics in a prospective cohort of patients with post-acute COVID-19 syndrome. Gut. 2022;71:544-52. DOI: https://doi.org/10.1136/gutjnl-2021-325989
Yan Z, Yang M, Lai CL. Long COVID-19 syndrome: a comprehensive review of its effect on various organ systems and recommendation on rehabilitation plans. Biomedicines. 2021;9:966. DOI: https://doi.org/10.3390/biomedicines9080966
Tomar BS, Singh M, Nathiya D, Sharma A, Sharma E, Bareth H, et al. prevalence of symptoms in patients discharged from COVID care facility of NIMS hospital: is RT PCR negativity truly reflecting recovery? A single-centre observational study. Int J Gen Med. 2021;14:1069-78. DOI: https://doi.org/10.2147/IJGM.S295499
Batiha GE, Al-kuraishy HM, Al-Gareeb AI, Welson NN. Pathophysiology of post-COVID syndromes: a new perspective. Virol J. 2022;19:158. DOI: https://doi.org/10.1186/s12985-022-01891-2
Antonelli M, Penfold RS, Merino J, Sudre C, Molteni E, Berry S, et al. Risk factors and disease profile of post- vaccination SARS-CoV-2 infection in UK users of the COVID symptom study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2022;22:43-55. DOI: https://doi.org/10.1016/S1473-3099(21)00460-6
Gao P, Liu J, Liu M. Effect of COVID-19 vaccines on reducing the risk of long COVID in the real world: a systematic review and meta-analysis. Int J Environ Res Public Health. 2022;19:12422. DOI: https://doi.org/10.3390/ijerph191912422
Ayoubkhani D, Bermingham C, Pouwels KB, Glickman M, Nafilyan V, Zaccardi f, et al. Trajectory of long covid symptoms after covid-19 vaccination: community based cohort study. BMJ. 2022;377:e069676. DOI: https://doi.org/10.1136/bmj-2021-069676
Fischer A, Zhang L, Elbéji A, Wilmes P, Oustric P, Staub T, et al. Long COVID symptomatology after 12 months and its impact on quality of life according to initial coronavirus disease 2019 disease severity. Open Forum Infect Dis. 2022;9:ofac397. DOI: https://doi.org/10.1093/ofid/ofac397
Bryson WJ. Long-term health-related quality of life concerns related to the COVID- 19 pandemic: a call to action. Qual Life Res. 2021;30:643-5. DOI: https://doi.org/10.1007/s11136-020-02677-1
Tsuzuki S, Miyazato Y, Terada M, Morioka S, Ohmagari N, Beutels P. Impact of long-COVID on health-related quality of life in Japanese COVID-19 patients. Health Qual Life Outcomes. 2022;20:125. DOI: https://doi.org/10.1186/s12955-022-02033-6
Strain WD, Sherwood O, Banerjee A, van der Togt V, Hishmeh L, Rossman J. The impact of covid vaccination on symptoms of long COVID: an international survey of people with lived experience of long COVID. Vaccines. 2022;10:652. DOI: https://doi.org/10.3390/vaccines10050652
Sarda R, Kumar A, Chandra A, Bir M, Kumar S, Soneja M, et al. Prevalence of long COVID-19 and its impact on quality of life among outpatients with mild COVID-19 disease at tertiary care center in North India. J Patient Exp. 2022;9:237437352211173. DOI: https://doi.org/10.1177/23743735221117358
Downloads
Publicado
Como Citar
Edição
Secção
Licença
Direitos de Autor (c) 2023 Acta Médica Portuguesa
Este trabalho encontra-se publicado com a Creative Commons Atribuição-NãoComercial 4.0.
Todos os artigos publicados na AMP são de acesso aberto e cumprem os requisitos das agências de financiamento ou instituições académicas. Relativamente à utilização por terceiros a AMP rege-se pelos termos da licença Creative Commons ‘Atribuição – Uso Não-Comercial – (CC-BY-NC)’.
É da responsabilidade do autor obter permissão para reproduzir figuras, tabelas, etc., de outras publicações. Após a aceitação de um artigo, os autores serão convidados a preencher uma “Declaração de Responsabilidade Autoral e Partilha de Direitos de Autor “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) e a “Declaração de Potenciais Conflitos de Interesse” (http://www.icmje.org/conflicts-of-interest) do ICMJE. Será enviado um e-mail ao autor correspondente, confirmando a receção do manuscrito.
Após a publicação, os autores ficam autorizados a disponibilizar os seus artigos em repositórios das suas instituições de origem, desde que mencionem sempre onde foram publicados e de acordo com a licença Creative Commons
