Study tracks health and quality of life of chronically ill COVID-19 patients months after discharge

Study tracks health and quality of life of chronically ill COVID-19 patients months after discharge

In a recently published study scientific reportResearchers investigated chronic critical illness (CCI) in coronavirus disease 2019 (COVID-19) survivors who sought intensive care units for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-) infection (ICU) and receive mechanical ventilation2).

Study tracks health and quality of life of chronically ill COVID-19 patients months after discharge
Study: Decreased health-related quality of life, fatigue, anxiety, and depression after chronic critical illness affect COVID-19 patients long-term. Image source: Starocean/Shutterstock.com

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Advances in critical care have greatly improved survival rates for patients with acute surgical, neurological, or cardiac critical illness. In severe cases, COVID-19 can also cause CCI.

CCI often affects older patients with sepsis and underlying comorbidities and reduces their health-related quality of life (HRQoL). In addition, ICU survivors suffer from compromised physical and mental health and cognitive abilities.

As a result, they require highly resource-intensive long-term intensive care, which imposes significant medical costs on the system, individuals, and their families. Therefore, it is critical to study the long-term outcomes (beyond survival) of COVID-19 ICU survivors, even if they receive short-term ICU treatment.

About the study

In this study, researchers recruited a prospective cohort of adult CCI COVID-19 patients admitted to a German neurological rehabilitation center to determine their health status and HRQoL 3, 6, and 12 months after discharge.

They relied on a definition derived from the US consensus to determine the presence of CCI, requiring at least eight days of ICU stay and any one of six clinical conditions: acute mechanical ventilation for ≥96 hours, sepsis, tracheostomy, stroke, severe wound, and traumatic brain injury. These patients received approximately 100 minutes of neurorehabilitation therapy per day.

Researchers conducted five study visits at different time points, where participants underwent functional testing and provided information about their living conditions. In addition, the team extracted data on complications of ICU treatment, characteristics and past comorbidities from their medical records.

They also performed electromyography and nerve conduction studies to investigate myopathies and neuropathies in critical illness. The Fatigue Severity Scale-7 (FSS-7) helps assess fatigue, with a cutoff of ≥4 indicating fatigue. Likewise, a Hospital Anxiety and Depression Scale (HADS) score >7 indicates clinically relevant anxiety and depression.

In addition, the EuroQol-5 Dimension 5 Levels (EQ-5D-5L) measures HRQoL, representing optimal health on a visual analog scale of 0-100. The team also assessed frailty, global disability and dyspnea using specific scales.

The team used linear mixed-effects models to examine the impact of preclinical health status and ICU treatment characteristics on HRQoL, fatigue, anxiety and depression over time. It adjusts for various covariates such as age, sex, comorbidities, etc. The team visually inspected the model assumptions and reported the results.

result

Of the 130 patients enrolled in the study between June 2020 and January 2022, only 97 patients entered the final analysis. The average length of stay in the ICU and mechanical ventilation was 52 and 39 days, respectively.

The prevalence of fatigue, anxiety, and depression was significantly higher at discharge (Visit 2) and at three-month follow-up, and remained elevated until the final study visit, one year after discharge from rehabilitation.

Therefore, HRQoL remained limited with no significant improvement until the last study visit. The index remained almost at a significantly lower level compared with the general German population of the same age (index value: 0.63 ± 0.33 vs. 0.87 ± 0.20). However, after receiving neurorehabilitation treatment, weakness, global disability, and dyspnea improved slightly.

Because systemic inflammation primarily contributes to critical illness polyneuropathy and myopathy, and 84% of the cohort were diagnosed with these conditions, 42% and 39% of patients in this study experienced anxiety and depression, respectively, and 68% and 84% reported Walking and pain problems or discomfort, respectively, 12 months after discharge from rehabilitation.

Furthermore, results from the EQ-5D-5L and HADS showed that most participants continued to suffer from post-intensive care syndrome (PICS) even more than a year after infection.

in conclusion

Overall, CCI patients who recovered from COVID-19 had high symptom burden even one year after discharge.

55%, 42%, 40%, 77% and 84% experienced severe fatigue, anxiety, depression, daily work problems, and pain and discomfort respectively.

These patients should receive special medical care even after discharge, especially for mental health issues.

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