Comparison of 6-Month Outcomes of Survivors of COVID-19 versus Non-COVID-19 Critical Illness

Abstract

Rationale: The outcomes of survivors of critical illness due to coronavirus disease (COVID-19) compared with non-COVID-19 are yet to be established. Objectives: We aimed to investigate new disability at 6 months in mechanically ventilated patients admitted to Australian ICUs with COVID-19 compared with non-COVID-19. Methods: We included critically ill patients with COVID-19 and non-COVID-19 from two prospective observational studies. Patients were eligible if they were adult (age ⩾ 8 yr) and received ⩾24 hours of mechanical ventilation. In addition, patients with COVID-19 were eligible with a positive laboratory PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Measurements and Main Results: Demographic, intervention, and hospital outcome data were obtained from electronic medical records. Survivors were contacted by telephone for functional outcomes with trained outcome assessors using the World Health Organization Disability Assessment Schedule 2.0. Between March 6, 2020, and April 21, 2021, 120 critically ill patients with COVID-19, and between August 2017 and January 2019, 199 critically ill patients without COVID-19, fulfilled the inclusion criteria. Patients with COVID-19 were older (median [interquartile range], 62 [55-71] vs. 58 [44-69] yr; P = 0.019) with a lower Acute Physiology and Chronic Health Evaluation II score (17 [13-20] vs. 19 [15-23]; P = 0.011). Although duration of ventilation was longer in patients with COVID-19 than in those without COVID-19 (12 [5-19] vs. 4.8 [2.3-8.8] d; P < 0.001), 180-day mortality was similar between the groups (39/120 [32.5%] vs. 70/199 [35.2%]; P = 0.715). The incidence of death or new disability at 180 days was similar (58/93 [62.4%] vs. 99/150 [66/0%]; P = 0.583). Conclusions: At 6 months, there was no difference in new disability for patients requiring mechanical ventilation for acute respiratory failure due to COVID-19 compared with non-COVID-19. Clinical trial registered with www.clinicaltrials.gov (NCT04401254).

Keywords: SARS-CoV-2; critical care; long COVID; long-term outcomes; recovery.

Figure 1.

Study flowcharts of (A) the original COVID-Recovery study and (B) the original PREDICT study (Predicting the Outcome of Critically Ill Patients). COVID-19 = coronavirus disease; EQ-5D-5L = EQ-5D-5 level; HADS = Hospital Anxiety and Depression Scale; IADL = Instrumental Activities of Daily Living; IES-6 = Impact of Events Scale-6; MoCA-BLIND = Montreal Cognitive Assessment; SPRINT-SARI = Short Period Incidence Study of Severe Acute Respiratory Infection; WHODAS = World Health Organization Disability Assessment Schedule.

Figure 2.

Kaplan-Meier curves of 6-month survival in patients with coronavirus disease (COVID-19) and non–COVID-19.

Figure 3.

World Health Organization Disability Assessment Schedule (WHODAS) score and EQ-5D-5 level (EQ-5D-5L) scale in patients with coronavirus disease (COVID-19) and non–COVID-19. (A) Comparison of WHODAS score at baseline and 6 months (P values from a mixed-effect quantile model considering a Τ = 0.50, an interior point algorithm, and including center as random effect). (B) Proportion of patients developing 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 EQ-5D-5L scale at baseline and 6 months (P values from a mixed-effect quantile model considering a Τ = 0.50, an interior point algorithm, and including center as random effect). (D) Proportion of patients not reporting problems with mobility, personal care, usual activities, pain/discomfort, or anxiety/depression. P values for comparisons are shown in Table 2. VAS = visual analogue scale.