Long Term Outcomes in COVID-19

Clinical Outcomes Among Patients With 1-Year Survival Following Intensive Care Unit Treatment for COVID-19

Heesakkers H, van der Hoeven JG, Corsten S, et al. JAMA. 2022 Feb 8;327(6):559-565. doi: 10.1001/jama.2022.0040.

Blog Written by Dr Jose Chacko

Design and study population

This prospective cohort study is part of the MONITOR IC study on ICU survivors. ICU patients who underwent treatment for COVID-19 were recruited from 11 hospitals in the Netherlands. Patients admitted during the first wave between March 1, 2020, and July 1, 2020, were eligible for inclusion and were recruited before hospital discharge or soon after.

Excluded

ICU admission for less than 12 hours, having a life expectancy of fewer than 48 hours, and those receiving palliative care.

Assessment of outcomes

Self-reported or report by proxy, either online or on paper. Evaluated on the domains of physical, mental, and cognitive function

Assessment of physical symptoms

Frailty Score: 1 (very fit) to 9 (terminally ill).  A score of ≥5 indicates frailty.

Checklist Individual Strength—fatigue subscale (a 7-point rating subscale of the CIS-20 measuring fatigue severity and consisting of 8 statements; range, 8–56 (value of ≥27 indicates severe fatigue)

30 physical problems rated on a 4-point Likert scale (none, mild, moderate, severe problems). Physical problems considered present if at least one problem was rated as moderate or severe

Assessment of mental symptoms

Mental symptoms of anxiety, depression, and post-traumatic stress disorder were assessed.

The Hospital Anxiety and Depression Scale (HADS) – two components: HADS-A (anxiety) and HADS-D (depression). Seven questions on a 4-point Likert scale (0-3), with a score of ≥8 indicates anxiety or depression

Impact of Event Scale-6 on a 5-point scale (0-4). A score of more than 1.75 suggests post-traumatic stress disorder

Assessment of cognitive symptoms

Abbreviated Cognitive Failure questionnaire: 14 questions on a Likert scale of 0-4; a score of >43 indicates severe symptoms

Ability to work

Ranging from full recovery “working as before” to incapacity “completely stopped working”

Patients were followed up for one year

Results

Demographic characteristics

Age: 61.2 (9.3) years

More men: 71.5%

APACHE IV score: 58.9 (16.6)

Ventilation: 14 (8-22) d

ICU stay: 18.5 (11-32_

Hospital stay: 30 (20-46)

Outcomes

Physical symptoms were reported by 74.3% (182/245), mental symptoms were reported by 26.2% (64/244) patients, cognitive symptoms were reported by 16.2% (39/241) patients. Overall, 30.6% of the participants reported symptoms in at least 2 domains; 10.5% experienced symptoms in all 3 domains at 1 year after ICU admission

Physical symptoms

Frailty: 6.1% (15/245)

Fatigue: 138/246 (56.1%)

Two-thirds reported new physical problems following ICU admission for COVID-19; weakened condition (38.9%), joint stiffness (26.3%), joint pain (25.5%), muscle weakness (24.8%), myalgia (21.3%), and dyspnea (20.8%)

57.8% of the survivors who were previously employed reported work-related problems (working for reduced duration or on sick leave).

Mental symptoms

Anxiety: 17.9% (44/246)

Depression: 18.3% (45/246)

PTSD: 9.8% (24/244)

Cognitive

16.2% (39/241)

Previous reports suggest higher incidence but were on follow up after a shorter duration

More sequelae after SARS and MERS

Mental symptoms lower after COVID-19 compared to other conditions associated with ICU admission

More patients with COVID-19 reported problems with the return to work compared to other conditions (58% vs. 43%)

Limitations

• Outcomes were patient or proxy reported; no physical follow-up
• No formal neuropsychological testing
• No information on modalities of treatment used in ICU (sedation, prone) or the presence of ICU delirium which could have impacted outcomes
• No information available on rehabilitation programs
• No comparator group to assess the specific impact of COVID-19-related ICU admission