Discordance between physical and cognitive health problems over one year after critical care: Insights from severe COVID-19 patients

Abstract

Objectives: To investigate the longitudinal evolution of physical and cognitive problems after hospital discharge in survivors of severe COVID-19; to describe the co-occurrence of these health problems domains in the following year after discharge; and evaluate if results are different taking into account the use of invasive mechanical ventilation.

Design: Prospective cohort study.

Setting: A large academic medical center in Brazil.

Participants: Patients aged ≥50 years who survived hospitalization for COVID-19 requiring critical care.

Measurements: We evaluated participants' status before hospital admission and one, three, six, nine, and twelve months after hospital discharge using validated questionnaires to measure frailty, persistent physical symptoms, and cognitive function. Clusters of physical and cognitive problems were defined using sequential analysis. Concordance was studied between different problems and trajectories, and after stratifying for use of invasive mechanical ventilation during ICU stay.

Results: We included 428 participants (median age was 63 years, 57% were male, 14% were frail before COVID-19, and 61% required mechanical ventilation). Physical and/or cognitive problems were experienced in 83% of responders at least once during follow-up, and half reported any problem even after one year. Most participants experienced health problems in a single health domain, with co-occurrence less than 9% in every assessment (Cramer's V bias-corrected less than 0.1 in any assessment). Sequential analysis identified three clusters each of cognitive and physical trajectories, with different evolution and no concordance. Stratifying the sample based on the use of mechanical ventilation did not change the results.

Conclusions: Severe COVID-19 survivors frequently experience physical and/or cognitive problems, yet these conditions and their trajectories are discordant. Multidimensional evaluations post-ICU discharge can aid in delivering tailored rehabilitation programs.

Keywords: Critical illness; Epidemiology; Mechanical ventilation; Post-acute COVID-19 syndrome; Survivors.

Fig. 1

Prevalence of physical and cognitive problems at each interview. Physical problems exhibited a progressive reduction, but no variation was observed for cognitive problems. Error bars are the 95% confidence intervals. The percentage is related to the number of patients who responded the questionnaire about each domain in that specific interview.

Fig. 2

Prevalence and co-occurrence of physical and/or cognitive problems in severe COVID-19 survivors during one year follow-up. Cramer’s V bias-corrected ≤0.1 in all interviews. The percentage is related to the number of patients who responded the questionnaire about each domain in that specific interview.

Fig. 3

(A) Clusters of physical trajectories during 1-year follow-up after severe COVID-19 hospitalization determined by sequence analysis. (B) Frequencies of the three clusters of physical trajectories after discharge for COVID-19 hospitalization. (1) No physical problems; (2) Initial short-term physical problems; (3) Long-term physical problems.

Fig. 4

(A) Clusters of cognitive trajectories during 1-year follow-up after severe COVID-19 hospitalization determined by sequence analysis. (B) Frequencies of the three clusters of physical trajectories after discharge for COVID-19 hospitalization. (1) No cognitive problems; (2) Initial short-term cognitive problems; (3) Late cognitive problems.