Fatigue Symptoms During the First Year Following ARDS

Abstract

Background: Fatigue is commonly reported by ARDS survivors, but empirical data are scarce.

Research question: This study evaluated fatigue prevalence and associated variables in a prospective study of ARDS survivors.

Study design and methods: This analysis is part of the ARDSNet Long-Term Outcomes Study (ALTOS) conducted at 38 US hospitals. Using age- and sex-adjusted, time-averaged random effects regression models, we evaluated associations between the validated Functional Assessment of Chronic Illness Therapy-Fatigue Scale with patient and critical illness variables, and with physical, cognitive, and mental health status at 6 and 12 months following ARDS.

Results: Among ARDS survivors, 501 of 711 (70%) and 436 of 659 (66%) reported clinically significant symptoms of fatigue at 6 and 12 months, respectively, with 41% and 28% reporting clinically important improvement and worsening (n = 638). At 6 months, the prevalence of fatigue (70%) was greater than that of impaired physical functioning (50%), anxiety (42%), and depression (36%); 46% reported both impaired physical function and fatigue, and 27% reported co-existing anxiety, depression, and fatigue. Fatigue was less severe in men and in those employed prior to ARDS. Critical illness variables (eg, illness severity, length of stay) had little association with fatigue symptoms. Worse physical, cognitive, and mental health symptoms were associated with greater fatigue at both the 6- and 12-month follow-up.

Interpretation: During the first year following ARDS, more than two-thirds of survivors reported clinically significant fatigue symptoms. Due to frequent co-occurrence, clinicians should evaluate and manage survivors' physical, cognitive, and mental health status when fatigue is endorsed.

Keywords: acute lung injury; cognitive function; depression; disability; rehabilitation.

Figure 1

Histogram of change in raw fatigue scores between 6- and 12-month follow-up (n = 638). Shown are the raw scores from the validated Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) scale (range, 0-52), with higher scores representing less fatigue. Minimally clinically important difference was indicated by a 3-point change in raw score; 181 of 638 (28%) patients had a decrease in score ≥ 3 points (representing increased fatigue); and 259 of 638 (41%) patients had an increase in score ≥ 3 points (representing decreased fatigue) from 6- to 12-month follow-up. A total of 94 FACIT-F scores at 6 and/or 12 months were missing.

Figure 2

Venn diagrams of fatigue symptoms with impaired physical function and cognition, and with depression and anxiety symptoms, at 6-month follow-up. a, n = 10 (1%); b, n = 4 (1%); c, n = 9 (1%). Fatigue, assessed by using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale score (percentage of cohort with score ≤ 68). Impaired physical function, assessed by using the Functional Performance Inventory-Short Form (percentage of cohort with score ≤ 2). Impaired cognition, assessed by using Mini-Mental State Examination (percentage of cohort with score ≤ 24). Anxiety and depression, assessed by using the Hospital Anxiety and Depression Scale (percentage of cohort with subscale scores ≥ 8). Missing data among 732 patients comprised the following: fatigue, n = 11; anxiety, n = 27; depression, n = 27; Functional Performance Inventory, n = 26; and Mini-Mental State Examination, n = 31.