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Multicenter Study
. 2025 Jun 8;12(1):e002789.
doi: 10.1136/bmjresp-2024-002789.

Long-term multidimensional patient-centred outcomes after hospitalisation for COVID-19: do not only focus on disease severity

Martine Bek  1 , Yasemin Türk  2 , Matthijs L Janssen  3   4   5 , Gemma Weijsters  2 , Julia C Berentschot  5 , Rita J G van den Berg-Emons  6 , Majanka H Heijenbrok-Kal  6   7 , Gerard M Ribbers  6   7 , Joachim Aerts  5 , Wessel E J J Hanselaar  2 , Henrik Endeman  4 , Merel E Hellemons  5 , Evert-Jan Wils  3   4 ; CO-FLOW collaboration group; Dutch HFNO COVID-19 study group; On behalf of
Collaborators, Affiliations
Multicenter Study

Long-term multidimensional patient-centred outcomes after hospitalisation for COVID-19: do not only focus on disease severity

Martine Bek et al. BMJ Open Respir Res. .

Abstract

Objectives: To investigate the association between COVID-19 disease severity during hospitalisation for COVID-19 and long-term multidimensional patient-centred outcomes up to 12 months post-hospitalisation. The secondary objective was to identify other risk factors for these long-term outcomes.

Methods: In this multicentre prospective cohort study, we categorised COVID-19 disease severity using the maximal level of respiratory support as proxy into (1) conventional oxygen therapy (COT), (2) high-flow nasal oxygen (HFNO) and (3) invasive mechanical ventilation (IMV). The primary outcome health-related quality of life (HRQoL), and the secondary outcomes self-reported symptoms and recovery were collected at 6 and 12 months post-hospitalisation.

Results: Data from 777 patients were analysed, with 226 (29%) receiving COT, 273 (35%) HFNO and 278 (36%) IMV. Patients reported impaired HRQoL, persistence of symptoms and poor recovery. Multivariable generalised estimating equations analysis showed that COVID-19 disease severity was not associated with HRQoL and inconsistently with symptoms; the HFNO group reported poorer recovery. Overall, female sex, younger age and pulmonary history were independent risk factors for outcomes.

Conclusions: COVID-19 disease severity was associated with self-perceived recovery, but not with HRQoL and inconsistently with symptoms. Our findings suggest that age, sex and pulmonary history are more consistent risk factors for long-term multidimensional outcomes and offer better guidance for aftercare strategies.

Keywords: COVID-19; Critical Care; Patient Outcome Assessment; Respiratory Infection.

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Conflict of interest statement

Competing interests: HE has received an unrestricted research grant from Fisher and Paykel Healthcare (Auckland, New Zealand) unrelated to this paper. The remaining authors have disclosed that they do not have any potential conflicts of interest related to this paper.

Figures

Figure 1
Figure 1. Health-related quality of life for different maximum levels of respiratory support at 6 and 12 months after hospital discharge. Boxplots showing distribution of health-related quality of life; (A) EQ-5D-5L utility score and (B) EQ-VAS at 6 and 12 months for the total cohort and for each level of respiratory support (COT, HFNO or IMV). Boxplots displaying mean, median, IQR and range. A box shows the upper and lower quartiles with the inside of the box indicating the IQR; the midline signifies the median; the whisker indicates the range with minimum and maximum values. The symbol X represents the mean. Dotted lines indicate the reference value of the Dutch population as median with IQRs. COT, conventional oxygen therapy; EQ-5D-5L, EuroQol Group 5 Level, 5 Dimension; EQ-VAS, EQ Visual Analogue Scale; HFNO, high-flow nasal oxygen; IMV, invasive mechanical ventilation.
Figure 2
Figure 2. Health-related quality of life and its risk factors at 6 and 12 months after hospital discharge. Forest plots presenting risk factors for health-related quality of life (A) EQ-5D-5L utility score and (B) EQ-VAS at 6 and 12 months after hospitalisation for COVID-19. Data are obtained using multivariable linear generalised estimating equations analysis. The EQ-5D-5L utility score was calculated according to the Dutch tariff for the EQ-5D-5L ranging from 0 (death) to 1 (best health possible). The EQ-VAS ranges from 0 (worst imaginable health) to 100 (best health), to assess subjective general health. BMI, body mass index; β, beta/estimated mean; COT, conventional oxygen therapy; EQ-5D-5L, EuroQol-5 Dimension-5 Level; HFNO, high-flow nasal oxygen; IMV, invasive mechanical ventilation; VAS, visual analogue scale.
Figure 3
Figure 3. Physical and respiratory symptom cluster and their risk factors at 6 and 12 months after hospital discharge. Forest plots presenting risk factors of (A) physical symptom cluster at 6 months, (B) physical symptom cluster at 12 months, (C) respiratory symptom cluster at 6 months and (D) respiratory symptom cluster at 12 months postdischarge. Data are obtained using multivariable binary generalised estimating equations analysis. Symptoms were assessed with the Corona Symptom Checklist. AOR, adjusted OR; BMI, body mass index; COT, conventional oxygen therapy; HFNO, high-flow nasal oxygen; IMV, invasive mechanical ventilation.
Figure 4
Figure 4. Recovery status and its risk factors at 6 and 12 months after hospital discharge. Forest plots presenting risk factors for self-reported recovery status from COVID-19. Data are obtained using multivariable generalised estimating equations analysis. Recovery status from COVID-19 was assessed with the Core Outcome Measure for Recovery. Recovery was dichotomised into good recovery (complete or mostly recovered) and poor recovery (not recovered at all, somewhat recovered, or half recovered). AOR, adjusted OR; BMI, body mass index; COT, conventional oxygen therapy; HFNO, high-flow nasal oxygen; IMV, invasive mechanical ventilation.
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