Estudo identifica fatores de risco para doença COVID de longa duração em adultos
Os pesquisadores da Clínica Mayo identificaram fatores de risco que podem fazer com que pacientes adultos com COVID-19 sofram sintomas que perduram por meses ou anos. A condição é frequentemente chamada de COVID de longa distância.
![](data:image/jpeg;base64,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)
Domínio público
Os pesquisadores da Clínica Mayo identificaram fatores de risco que podem fazer com que pacientes adultos com COVID-19 sofram sintomas que perduram por meses ou anos. A condição é frequentemente chamada de COVID de longa distância. As descobertas são relatadas no Journal of Investigative Medicine .
Os pesquisadores entrevistaram mais de 3.000 adultos com mais de 18 anos que foram tratados pelas clínicas virtuais de COVID-19 da Mayo Clinic na Flórida, Arizona e Minnesota entre março de 2020 e março de 2021.
Eles revisaram os sintomas dos pacientes, a incidência de COVID de longa duração no grupo e quantos foram hospitalizados devido à COVID-19. Os pacientes também foram solicitados a avaliar sua percepção sobre a gravidade de seus sintomas, se receberam diagnóstico de COVID de longa duração, quanto tempo demoraram para retomar suas atividades habituais e quanto tempo faltaram ao trabalho.
Resultados do estudo
“Descobrimos que os pacientes com sintomas graves de COVID-19 eram mais propensos a ter COVID de longa duração do que aqueles que apresentavam sintomas leves ”, disse Bala Munipalli, MD, internista da Clínica Mayo na Flórida e co-autor sênior do estudo. “A maioria delas eram mulheres que foram hospitalizadas, sofreram impactos psicológicos da COVID-19, como ansiedade e depressão, e precisaram de mais de um mês para retornar às suas atividades normais após a doença”.
A idade média dos entrevistados no estudo foi de 54 anos e a maioria eram mulheres, incluindo 57% dos pacientes pesquisados que relataram sintomas graves ; 60% com sintomas leves; e 65% com sintomas moderados.
A maioria dos pacientes (92%) com sintomas leves conseguiu retomar seus horários habituais dentro de quatro semanas após a infecção por COVID-19, mas 23% desses pacientes com infecção aguda leve desenvolveram COVID de longa duração.
Significativamente mais pacientes (37,4%) com sintomas graves foram hospitalizados do que aqueles com sintomas leves (0,9%) ou moderados (4,8%). Os pacientes hospitalizados também relataram sintomas persistentes de COVID de longa duração (67%), precisando de um mês ou mais para retomar suas atividades habituais, faltando ao trabalho por pelo menos três semanas e tendo efeitos colaterais psicológicos negativos.
A maioria dos entrevistados no estudo relatou sintomas de COVID de longa duração que duraram de três a seis meses, com sintomas variando em gravidade. Os sintomas mais comuns no grupo de estudo foram fadiga, perda de olfato, alteração do paladar, falta de ar e sono insatisfatório.
Mais para aprender
"A incapacidade de retomar as atividades normais dentro de um mês após a COVID-19 aguda pode ser um fator preditivo para a COVID de longa duração. À medida que continuamos a estudar esta doença, esperamos obter uma melhor compreensão de quem é suscetível a ela, os sintomas que permanecem persistentes e como tratar melhor esses pacientes no início da doença", diz o Dr. Munipalli.
"Estudos adicionais podem ajudar a orientar a padronização de futuras ferramentas de avaliação para avaliar a deficiência e também fornecer informações valiosas para empregadores, educadores, legisladores e pacientes."
Os investigadores observam que é necessária uma abordagem multidisciplinar à COVID de longa duração e que os profissionais de saúde devem reconhecer os principais sintomas, obter um historial médico e um exame físico cuidadosos , bem como prestar muita atenção às condições médicas comórbidas em pacientes com sintomas persistentes .
Munipalli diz que sua equipe planeja pesquisas adicionais com foco em tratamentos para COVID de longa duração.
Mais informações: Bala Munipalli et al, Fatores de risco para sequelas pós-agudas de COVID-19: resultados de pesquisa de um hospital terciário, Journal of Investigative Medicine (2023). DOI: 10.1177/10815589231190560
Informações do periódico: Journal of Investigative Medicine