Short-term health-related quality of life, physical function and psychological consequences of severe COVID-19

Abstract

Background Survivors of severe COVID-19 are at risk of impaired health-related quality of life (HRQoL) and persistent physical and psychological disability after ICU and hospital discharge. The subsequent social burden is a major concern. We aimed to assess the short-term HRQoL, physical function and prevalence of post-traumatic stress symptoms of invasively mechanically ventilated COVID-19 patients treated in our ICU. Methods Prospective, observational cohort study in a follow-up clinic. Patients completed a 6-min walking test (6MWT) to assess their cardio-pulmonary function around 2 months (early follow-up) from hospital discharge, the EQ-5D-5L questionnaire for quality of life assessment around 2 months and at 6 months from hospital discharge and an anonymous web-based Impact of Event Scale-Revised (IES-R) questionnaire for Post-Traumatic Stress symptoms at 2 months. Results 47 patients attended our follow-up program, mean age 59 ± 10 years, median pre-morbid Clinical Frailty Scale (CFS) 2 [2–3]. The median distance walked in 6 min was 470 [406–516] m, 83 [67–99]% of the predicted value. Overall 1 out 3 patients and 4/18 (22%) among those with a good functional baseline prior to COVID-19 (CFS of 1 or 2) had lower (84%) than predicted 6MWT. EQ-5D-5L quality of life VAS was 80 [70–90] out of 100 at early follow-up with a slight improvement to 85 [77.5–90] at 6 months. Mobility, self-care and usual activities improved between the two timepoints, while pain/discomfort and depression/anxiety did not improve or got worse. The IES-R total score was greater than the threshold for concern of 1.6 in 27/41(66%) respondents. Conclusions Patients recovering from severe COVID-19 requiring invasive mechanical ventilation surviving hospital discharge present with early mild to moderate functional impairment, mildly reduced quality of life from hospital discharge with an overall improvement of mobility, self-care and the ability of performing usual activities, while a worsening of pain and depression/anxiety symptoms at 6 months and a large proportion of symptoms of post-traumatic distress soon after hospital discharge.

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

“…On the other hand, in our study population DLCO impairment degree, which is the most reported respiratory functional impairment in post-COVID syndrome, was not associated with ARDS severity. Even if potentially controversial, this result confirms that COVID-19 patients requiring intensive care and IMV can fully recover [32,33].…”

The Good and Bad of Nrf2: An Update in Cancer and New Perspectives in COVID-19

“…The pandemic COVID-19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has dramatically affected human life and the world economy with more than 178 million confirmed cases and 3.8 million deaths (June 2021, WHO COVID-19 dashboard). At the same time, it has launched a challenge to researchers all over the world to identify the molecular features of viral infection and propagation in order to find the most appropriate therapy [100][101][102][103][104]. The SARS-CoV-2 virus is characterized by high infectivity and mutability, lethality and variant morbidity [105].…”

Risk of post-traumatic stress symptoms in hospitalized and non-hospitalized COVID-19 recovered patients. A cross-sectional study

“…Post-traumatic stress disorder (PTSD) rates are particularly high among patients with more severe COVID-19-related symptoms ( Chamberlain et al, 2021 ; Greenberg and Rafferty, 2021 ). Specifically, patients who require admission to Intensive Care Units (ICU) for treatment of acute COVID-19 are at increased risk of developing post-traumatic symptoms ( Carenzo et al, 2021 ; Herridge et al, 2011 ). Indeed, it is known that traumatic experiences confronting the individual unexpectedly with death, a danger to life, or a threat to physical and mental integrity may cause difficulty regulating emotional states and tolerating negative emotions ( La Rosa et al, 2021 ).…”