The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: a prospective cohort study

Abstract

Background: There are few reports of new functional impairment following critical illness from COVID-19. We aimed to describe the incidence of death or new disability, functional impairment and changes in health-related quality of life of patients after COVID-19 critical illness at 6 months.

Methods: In a nationally representative, multicenter, prospective cohort study of COVID-19 critical illness, we determined the prevalence of death or new disability at 6 months, the primary outcome. We measured mortality, new disability and return to work with changes in the World Health Organization Disability Assessment Schedule 2.0 12L (WHODAS) and health status with the EQ5D-5L^TM.

Results: Of 274 eligible patients, 212 were enrolled from 30 hospitals. The median age was 61 (51-70) years, and 124 (58.5%) patients were male. At 6 months, 43/160 (26.9%) patients died and 42/108 (38.9%) responding survivors reported new disability. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06-13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5L^TM utility score (MD, - 0.19 [- 0.28 to - 0.10]; p < 0.001). At 6 months, 82 of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty.

Conclusions: At six months after COVID-19 critical illness, death and new disability was substantial. Over a third of survivors had new disability, which was widespread across all areas of functioning. Clinical trial registration NCT04401254 May 26, 2020.

Keywords: COVID-19; Disability; Intensive care; Long-term outcome; Mechanical ventilation.

Fig. 1

Study flowchart. SPRINT-SARI = WHODAS = The World Health Organization Disability Assessment Schedule 2.0 12 level; HADS = Hospital Anxiety and Depression Scale; IES-6 = Impact of Events Scale-6 questions; MoCA-Blind = Montreal Cognitive Assessment Score-Blind; IADL = Instrumental activities of Daily Living

Fig. 2

WHODAS Score and EQ-5D-5L Scale. a Comparison of WHODAS score at baseline and 6 months (p value from a mixed-effect quantile models considering a Τ = 0.50, an interior point algorithm, and including patients as random effect). b Proportion of patients who have died or who have developed no (WHODAS < 5%), mild (5% ≤ WHODAS < 25%), moderate (25% ≤ WHODAS < 50%) or severe (50% ≤ WHODAS < 96%) disability. P values for comparisons are shown in Table 2. c Comparison of health status using the EQ-VAS at baseline and 6 months (p value from a mixed-effect quantile models considering a Τ = 0.50, an interior point algorithm, and including patients as random effect). d the domains of the EQ5D-5L, including the proportion of patients who reported no problems with mobility, personal care, usual activities, pain/discomfort or anxiety/depression. P values for comparisons are shown in Table 2

Fig. 3

New disability at 6 months according to baseline disability. Proportion of patients with new disability compared to baseline disability. No single item of the WHODAS 2.0 12L accounted for new disability. There was a wide range of new disabilities across all items

Fig. 4

Persistent symptoms at 6 months. a Intersection plot showing the most prevalent symptoms and combinations of symptoms at 6 months. b Symptoms at acute phase (at hospital admission) and after 6 months of COVID-19. Fatigue combines fatigue and/or loss of strength