Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study

Abstract

Background: Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes. We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested. Methods: We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters. Results: We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV. Conclusions: HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations. Trial registration: NCT04411459. 15D score 3 months -mean ± SD 0.857 ± 0.133 0.927 ± 0.061 0.800 ± 0.135 0.853 ± 0.114 0.637 ± 0.204 < 0.001 15D score 1 year -mean ± SD 0.880 ± 0.115 0.964 ± 0.033 0.820 ± 0.068 0.866 ± 0.088 0.572 ± 0.112 < 0.001 Mobility -mean ± SD 0.876 ± 0.207 0.963 ± 0.104 0.828 ± 0.191 0.901 ± 0.166 0.375 ± 0.298 < 0.001 Vision -mean ± SD 0.953 ± 0.119 0.992 ± 0.040 0.942 ± 0.108 0.949 ± 0.094 0.681 ± 0.280 < 0.001 Hearing -mean ± SD 0.968 ± 0.098 1.000 ± 0.000 1.000 ± 0.000 0.745 ± 0.135 0.857 ± 0.192 < 0.001 Breathing -mean ± SD 0.746 ± 0.238 0.879 ± 0.154 0.620 ± 0.227 0.753 ± 0.223 0.438 ± 0.238 < 0.001 Sleeping -mean ± SD 0.838 ± 0.238 0.940 ± 0.135 0.716 ± 0.274 0.929 ± 0.142 0.632 ± 0.312 < 0.001 Eating -mean ± SD 0.979 ± 0.102 1.000 ± 0.000 1 .000 ± 0.000 1.000 ± 0.000 0.587 ± 0.221 < 0.001 Speech -mean ± SD 0.980 ± 0.090 0.996 ± 0.032 0.996 ± 0.036 0.948 ± 0.117 0.777 ± 0.276 < 0.001 Excretion -mean ± SD 0.974 ± 0.110 1.000 ± 0.000 1.000 ± 0.000 0.872 ± 0.191 0.720 ± 0.292

Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms

“…Three studies [25,34,35] showed a higher risk of long-term symptoms in severe/critical patients than non-severe patients in terms of the acute infection status, one study [36] found such association only for muscle fatigue but not for other symptoms, and another study [32] did not detect the association. In addition, one study [28] reported higher prevalence of long-term symptoms in hospitalised patients than non-hospitalised patients, and another study [24] found a positive association between duration of invasive mechanical ventilation and post-COVID dyspnoea at one-year follow-up.…”

Prevalence of post-intensive care syndrome in mechanically ventilated patients with COVID-19

“…Some of them with larger samples, but with a smaller number of patients requiring invasive mechanical ventilation 6 , 7 , 21 . Only two studies 17 , 19 have assessed the three PICS domains focused on ventilated patients: the first one 17 assessed a cohort of 47 patients 6 months after hospital discharge, and the second one 19 analyzed a cohort of 178 patients at 3 and 12 months after hospital discharge.…”

“…Of note, follow-up consultations in that study 16 were via telematics at 1 month after hospital discharge. Gamberini et al 19 found that most of the patients reported persistent symptoms 1 year after ICU discharge, with dyspnea (58%) being the most frequent symptom. Heesakers et al 21 , also 1 year after ICU treatment, reported physical symptoms in 74% (weakness 38.9%), mental symptoms in 26% and cognitive symptoms in 16% of the patients, of whom 81% underwent mechanical ventilation.…”

“…Psychiatric disorders have been described in up to 49% 16 while cognitive disturbances reach 57% 35 at 1 month and 6 weeks of follow-up respectively. At 1 year following ICU treatment, mental symptoms were reported by 38% 19 and cognitive symptoms by 16% 21 .…”

“…Short and long-term sequelae of SARS-CoV-2 infection in patients admitted in ICU have been described 6 – 22 . However, PICS (in all 3 domains) in post-critical care mechanically ventilated COVID-19 patients has not been extensively studied 10 , 11 , 17 , 19 .…”