Long-Term Disabilities in ICU Survivors of COVID-19

Abstract

Background: COVID-19 is associated with prolonged disability, particularly after critical illness. This study aimed to assess and compare disability post-hospital discharge of subjects who were invasively ventilated versus those who were not, following ICU admission due to COVID-19. This study also explored variables associated with long-term disability.

Methods: In this prospective cohort study, subjects with COVID-19 who received invasive ventilation, noninvasive ventilation, or high-flow nasal cannula during ICU stay were assessed with the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 at 3 and 6 months post-hospital discharge. Data were analyzed collectively and stratified as subjects with and without invasive mechanical ventilation. Analysis of variance and multiple regression analyses were applied.

Results: The subjects (N = 43) were mainly male, middle age, and overweight. Subjects who were invasively ventilated (n = 21) had decreased physical function compared to those who were not during hospital assessments. From 3-6 months after discharge, all WHODAS domains and the overall score decreased in both groups (P < .001), indicating disability recovery. The participation domain, which assesses joining in society, was the only domain that remained worse in the ventilation group compared to the no ventilation group (P = .01). No interaction was found between time and the study groups, suggesting that the recovery trajectory was similar. At 6 months, considering the entire cohort, 70% and 56% had no disability in self-care and getting along domains, respectively, while 42% exhibited moderate to severe disability in the participation domain. According to the overall WHODAS score, 86% of subjects still had some level of disability at 6 months. In multivariate analyses, the overall WHODAS score along with the household and participation domains showed significant positive correlations, indicating higher disability, with corticosteroid use.

Conclusions: Disability persisted at 6 month post-hospital discharge for ICU survivors of COVID-19, regardless of the need for invasive mechanical ventilation. Participation was the only domain that showed higher disability among those who received invasive ventilation.

Keywords: disability; intensive care; long-term outcomes; mechanical ventilation; post–COVID-19 condition.

Fig. 1.

Flow chart.

Fig. 2.

Levels of disability for subjects with and without invasive mechanical ventilation at 3- and 6-month post–hospital discharge. Levels of disability were classified as follow: 0 = no disability (World Health Organization Disability Assessment Schedule [WHODAS] < 5%), 1 = mild (5% ≤ WHODAS < 25%), 2 = moderate (25% ≤ WHODAS < 50%), 3 = severe (50% ≤ WHODAS < 96%), and 4 = very severe (96% ≤ WHODAS ≤ 100%). Blue and red represent median levels of disability, while lines in gray show individuals’ levels of disability. *Analysis of variance within factor (time: 3 months vs 6 months), P ≤ .001. ^†Analysis of variance between factor (groups: invasive ventilation vs no invasive ventilation), P ≤ .001. A: Cognition, B: mobility, C: self-care, D: getting along, E: household, F: participation, and G: overall score.

Fig. 3.

Distribution of subjects according to levels of disability 3 and 6 months post–hospital discharge. Levels of disability were classified as follow: none (World Health Organization Disability Assessment Schedule [WHODAS] < 5%), mild (WHODAS 5–24%), moderate (WHODAS 25–49%), severe (WHODAS 50–95%), and very severe (WHODAS 96–100%). A: Cognition, B: mobility, C: self-care, D: getting along, E: household, F: participation, and G: overall score.