Long-term outcomes following severe COVID-19 infection: a propensity matched cohort study

Abstract

Background: There are limited data describing the long-term outcomes of severe COVID-19. We aimed to evaluate the long-term psychosocial and physical consequences of severe COVID-19 for patients.

Methods: We conducted a multicentre observational cohort study; between 3 and 7 months posthospital discharge, patients who had been admitted to critical care due to severe COVID-19 were invited to an established recovery service. Standardised questionnaires concerning emotional, physical and social recovery, including information on employment, were completed by patients. Using propensity score matching, we explored outcomes between patients admitted to critical care with and without COVID-19, using data from the same recovery programme.

Results: Between July 2020 and December 2020, 93 patients who had been admitted to critical with COVID-19 participated. Emotional dysfunction was common: 46.2% of patients had symptoms of anxiety and 34.4% symptoms of depression. At follow-up 53.7% of previously employed patients had returned to employment; there was a significant difference in return to employment across the socio-economic gradient, with lower numbers of patients from the most deprived areas returning to employment (p=0.03). 91 (97.8%) COVID-19 patients were matched with 91 non-COVID-19 patients. There were no significant differences in any measured outcomes between the two cohorts.

Interpretation: Emotional and social problems are common in survivors of severe COVID-19 infection. Coordinated rehabilitation is required to ensure patients make an optimal recovery.

Keywords: ARDS; COVID-19.

Figure 1

Patient flow through the study (invitation through to participation). InS:PIRE, Intensive Care Syndrome: Promoting Independence and Return to Employment; MDT, multidisciplinary team.

Figure 2

Distribution of hospital (A) and critical care (B) length of stay and APACHE II scores (C) in those returning to, and not returning to employment. APACHE II, Acute Physiology and Chronic Health Evaluation II.

Figure 3

Breakdown in return to baseline employment status across the SIMD quintiles. SIMD, Scottish Index of Multiple Deprivation.

Figure 4

Distribution of EQ-5D (HUS) (A) EQ-5D VAS (B) HADS anxiety (C) and HADS depression (D) across the COVID-19 and the non-COVID-19 cohorts. HADS, Hospital Anxiety and Depression Score; HUS, Health Utility Score; VAS, Visual Analogue Scale.