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.

Keywords: 6-min walking test; COVID-19; Follow-up; Health Related Quality of Life; Post-Traumatic Stress Disorder.

Fig. 1

Enrollment of patients following hospital discharge. Between March 1st, 2020 and May 15th, 2020 a total of 86 laboratory confirmed COVID-19 ARDS patients were discharged from the hospital following an ICU stay. Of these 25 died during their ICU stay and 12 received noninvasive ventilation only. No deaths were observed after ICU discharge. A total of 49 patients were discharged alive following at least 48 h of mechanical ventilation in the study period. Overall, 31 (63%) patients performed the 6MWT, 47 (96%) completed the EQ-5D-5L questionnaire in person (33 patients) or by telephone (14 patients), and 41 (84%) completed the web-based IES-R questionnaire

Fig. 2

Individual data (black dots) are presented as percentage of predicted values for healthy subjects of same age, sex and body mass index. Patients are grouped according to their premorbid Clinical Frailty Scale (CSF)