Health-related quality of life and stress-related disorders in COVID-19 ICU survivors: Are they worse than with other causes of ARDS?

Abstract

Background: There are insufficient data regarding the impact of acute respiratory distress syndrome related to coronavirus disease 2019 (C-ARDS) - caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - on health-related quality of life (HRQoL) and the occurrence of stress-related disorders in coronavirus disease 2019 (COVID-19) intensive care unit (ICU) survivors. The aim of this study is to assess HRQoL and the occurrence of stress-related disorders (acute stress disorder [ASD] and post-traumatic stress disorder [PTSD]) in C-ARDS ICU survivors at 1 and 6 months following hospital discharge.

Methods: This prospective observational study included 90 patients treated for C-ARDS between March and May 2020 in the ICU and discharged alive from the hospital. All patients included in the study were contacted by telephone 1 month and 6 months post-hospital discharge to assess the presence of symptoms of stress-related disorders and HRQoL using the 8-item Treatment Outcome Post-traumatic Stress Disorder scale (TOP-8) and 36-item Short Form survey (SF-36). We performed univariate analyses to evaluate differences between patients who developed stress and those who did not. We also compared SF-36 scores in our sample with data from the general Spanish population and from cohorts of non-C-ARDS and severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) survivors.

Results: There are 24.1% of patients showed symptoms of ASD; in 13.5% of cases the symptoms persisted 6 months later. Risk factors for the development of symptoms of ASD and PTSD are younger age, female sex, obesity, a previously diagnosed psychiatric disease and disease severity at ICU admission (P < 0.05). HRQoL was greatly affected by C-ARDS; however, there was improvement on all scales of the SF-36 at the 6-month follow-up (P < 0.05). The mean SF-36 score of our sample was higher than those previously reported in non-C-ARDS survivors (P < 0.05) for physical functioning (78.0 vs. 52.0), role functioning/physical (51.0 vs. 31.0), bodily pain (76.1 vs. 57.0), vitality (58.6 vs. 48.0), social function (72.6 vs. 63.0) and role emotional (77.4 vs. 55.0), except on the general health scale. C-ARDS survivors also scored better than SARS-CoV-1 survivors on all scales except for body pain (P < 0.05).

Conclusions: The impact of C-ARDS on HRQoL is substantial, with frequent occurrence of PTSD symptoms. Patients are heavily affected in all areas of health in the first month of post-hospital discharge but show a dramatic improvement within 6 months, especially in terms of physical health.

Keywords: COVID-19; Health-related quality of life; Post-intensive care syndrome; Post-traumatic stress disorder; Respiratory distress syndrome, Adult.

Figure 1

Flow diagram of patient selection. ARDS: Acute respiratory distress syndrome; C-ARDS: Coronavirus disease 2019-related acute respiratory distress syndrome; HRQoL: Health-related quality of life; ICU: Intensive care unit; PTSD: Post-traumatic stress disorder.

Figure 2

Results of SF-36 at the 1 month and 6 months follow-up and in the general population.BP: Bodily pain; COVID-19: Coronavirus disease 2019; GH: General health; MH: Mental health; PF: Physical functioning; RE: Role functioning/emotional; RP: Role functioning/physical; SF: Social functioning; SF-36: 36-Item Short Form survey; V: Vitality.*P < 0.05 for COVID-19 (1 month) vs. general population; ^†P < 0.05 for COVID-19 (1 month) vs. COVID-19 (6 months); ^‡P < 0.05 for COVID-19 (6 months) vs. general population.

Figure 3

Results of SF-36 of SARS-CoV-1 ARDS, C-ARDS and non–C-ARDS survivors at 6 months. ARDS: Acute respiratory distress syndrome; BP: Bodily pain; GH: General health; MH: Mental health; PF: Physical function; RE: Role functioning/emotional; RP: Role functioning/physical; SARS-CoV-1: Severe acute respiratory syndrome coronavirus-1; SF: Social function; SF-36: 36-Item Short Form survey; V: Vitality. *P < 0.05 for C-ARDS survivors (6 months) vs. non–C-ARDS survivors (6 months); ^†P < 0.05 for C-ARDS survivors (6 months) vs. SARS-CoV-1 ARDS survivors (6 months).