Prospective single-center study of health-related quality of life after COVID-19 in ICU and non-ICU patients

Abstract

Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87% and 80% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24% of non-ICU and 3% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5% of non-ICU and 10% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.

Figure 1

Screening and follow-up. Patients with COVID-19 treated at the University hospital of Würzburg were prospectively screened for study inclusion upon admission. After written consent, baseline characteristics were obtained and follow-up telephone interviews were conducted after 3- and 12-months, respectively.

Figure 2

EQ5D-5L dimensions. Each of the five dimensions of the EQ5D-5L displayed as the percentage of patients within the respective category at the 3- and 12-month follow-ups. More than half of ICU patients were limited in their mobility with severe problems in 23% vs. 7% in non-ICU patients. In non-ICU patients 56% had no mobility problems vs. 41% in ICU patients. Moderate or slight problems in self-care were more common in ICU patients. However, in both ICU and non-ICU patients around 80% reported no problems after 12 months. Nevertheless, 15% of ICU patients had severe problems to perform their usual activities compared to 2% in non-ICU patients. Only 25% of the ICU patients reported no problems, compared to 53% in non-ICU patients after 12-months. Extreme pain was not observed in any group, while severe pain was present in 7% of both ICU and non-ICU patients. However, moderate pain remained in 37% of ICU patients compared to only 7% in non-ICU patients. Anxiety/depression was reported in similar percentages in both groups along all categories, with 10 to 11% having severe or extreme problems in total.