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Randomized Controlled Trial
. 2023 Feb;49(2):166-177.
doi: 10.1007/s00134-022-06953-1. Epub 2023 Jan 3.

Association between acute disease severity and one-year quality of life among post-hospitalisation COVID-19 patients: Coalition VII prospective cohort study

Regis Goulart Rosa  1   2   3 , Alexandre Biasi Cavalcanti  4   5 , Luciano César Pontes Azevedo  4   6 , Viviane Cordeiro Veiga  4   7 , Denise de Souza  8 , Rosa da Rosa Minho Dos Santos  8 , Raíne Fogliati de Carli Schardosim  8 , Gabriela Soares Rech  8 , Geraldine Trott  8 , Daniel Schneider  8 , Caroline Cabral Robinson  8 , Tainá Aparecida Haubert  8 , Victoria Emanuele Lobo Pallaoro  8 , Liége Gregoletto Brognoli  8 , Ana Paula de Souza  8 , Lauren Sezerá Costa  8 , Bruna Machado Barroso  8 , Melissa Pezzetti Pelliccioli  8 , Janine Gonzaga  8 , Nicole Dos Santos Studier  8 , Ana Paula Aquistapase Dagnino  8 , Juliana de Mesquita Neto  8 , Sabrina Souza da Silva  8 , Bruna Dos Passos Gimenes  8 , Vanessa Brzoskowski Dos Santos  8 , Gabriel Pozza Muller Estivalete  8 , Carolina de Moraes Pellegrino  9 , Carisi Anne Polanczyk  8   10   11 , Letícia Kawano-Dourado  5 , Bruno Martins Tomazini  4   5   6 , Thiago Costa Lisboa  4   12   13 , Cassiano Teixeira  4   13   14 , Fernando Godinho Zampieri  4   5   15 , Alexandre Prehn Zavascki  8   16   17 , Bernard J Gersh  18 , Álvaro Avezum  19 , Flávia Ribeiro Machado  4   20 , Otavio Berwanger  15 , Renato Delascio Lopes  21 , Maicon Falavigna  8   22   11
Affiliations
Randomized Controlled Trial

Association between acute disease severity and one-year quality of life among post-hospitalisation COVID-19 patients: Coalition VII prospective cohort study

Regis Goulart Rosa et al. Intensive Care Med. 2023 Feb.

Abstract

Purpose: To assess the association between acute disease severity and 1-year quality of life in patients discharged after hospitalisation due to coronavirus disease 2019 (COVID-19).

Methods: We conducted a prospective cohort study nested in 5 randomised clinical trials between March 2020 and March 2022 at 84 sites in Brazil. Adult post-hospitalisation COVID-19 patients were followed for 1 year. The primary outcome was the utility score of EuroQol five-dimension three-level (EQ-5D-3L). Secondary outcomes included all-cause mortality, major cardiovascular events, and new disabilities in instrumental activities of daily living. Adjusted generalised estimating equations were used to assess the association between outcomes and acute disease severity according to the highest level on a modified ordinal scale during hospital stay (2: no oxygen therapy; 3: oxygen by mask or nasal prongs; 4: high-flow nasal cannula oxygen therapy or non-invasive ventilation; 5: mechanical ventilation).

Results: 1508 COVID-19 survivors were enrolled. Primary outcome data were available for 1156 participants. At 1 year, compared with severity score 2, severity score 5 was associated with lower EQ-5D-3L utility scores (0.7 vs 0.84; adjusted difference, - 0.1 [95% CI - 0.15 to - 0.06]); and worse results for all-cause mortality (7.9% vs 1.2%; adjusted difference, 7.1% [95% CI 2.5%-11.8%]), major cardiovascular events (5.6% vs 2.3%; adjusted difference, 2.6% [95% CI 0.6%-4.6%]), and new disabilities (40.4% vs 23.5%; adjusted difference, 15.5% [95% CI 8.5%-22.5]). Severity scores 3 and 4 did not differ consistently from score 2.

Conclusions: COVID-19 patients who needed mechanical ventilation during hospitalisation have lower 1-year quality of life than COVID-19 patients who did not need mechanical ventilation during hospitalisation.

Trial registration: ClinicalTrials.gov NCT04376658.

Keywords: Artificial; COVID-19; Critical care outcomes; Post-acute COVID-19 syndrome; Respiration.

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Conflict of interest statement

RGR reports research grants from Pfizer related to this submitted work, and research grants from Pfizer and Brazilian Ministry of Health and lectures fees from Novartis outside of this submitted work. CAP declares research grants from National Institute for Health Technology Assessment, FAPERGS, CNPq, and Brazilian Ministry of Health (PROADI-SUS), and consultant and lecture fees from Novartis, Roche, Bayer, Bristol-Meyers-Squibb, Amgen, Pfizer, Astrazeneca outside of this submitted work. LKD reports research grants from Brazilian Ministry of Health (PROADI-SUS), Boehringer Ingelheim, Bristol-Myers-Squibb and consulting fees from Lilly, Roche and Gilead outside of this submitted work. FGZ reports research grants from Ionis Pharmaceuticals and Bactiguard and consultant from Bactiguard. APZ reports research grants from Pfizer and consultant from fees Spero Therapeutics outside of this submitted work. OB reports research grants from AstraZeneca, Pfizer, Bayer, Boehringer Ingelheim, Servier, and Amgen outside of this submitted work. RDL reports research grants from BMS, Glaxo Smith Kline, Medtronic, Portola, Bayer, Pfizer, Sanofi, Daiichi Sankyo, Merck and Boehringer Ingleheim, and consulting fees from Bayer, BMS, Glaxo Smith Kline, Portola, Merck, Boehringer Ingleheim, Daiichi Sankyo, Medtronic, Sanofi and Pfizer outside of this submitted work. The other authors have no conflict to declare.

Figures

Fig. 1
Fig. 1
Flow diagram of post-hospitalisation survivors of COVID-19. RCT randomised clinical trial. 11120 survivors and 36 dead patients
Fig. 2
Fig. 2
Effect of COVID-19 severity on EQ-5D-3L utility scores at 3, 6, 9, and 12 months
See this image and copyright information in PMC

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