Study reveals long-term challenges for ICU patients

In a recent article published in the journal scientific reportresearchers conducted a prospective study at the University Hospital of Würzburg, Germany, in patients with coronavirus disease 2019 (COVID-19) who sought hospitalization to determine how post-recovery health-related quality of life (HRQoL) was. determined whether it affected

This study included 85 patients admitted to intensive care units (ICU) and non-ICU units for COVID-19-related complications between March 2020 and December 2020.

study: A single-center, prospective study of health-related quality of life after COVID-19 in ICU and non-ICU patientsImage credit: p.ill.i / Shutterstock

Background

COVID-19 presents as an asymptomatic infection with severe disease, but does not end in patient survival. Fatigue, cognitive impairment, post-traumatic stress disorder (PTSD), and muscle weakness persist long-term in the majority of recovered patients, interfering with QoL.

Several recent meta-analyses suggested that HRQoL remained low in female and elderly patients, but was persistently impaired in all patients studied. QoL is multifaceted with components of physical and mental health. However, socioeconomic conditions and environment also play a role.

Previous studies have used traditional parameters such as mortality and other physiological measures to derive correlations between disease and QoL. However, self-perceived physical and mental states have become more recognized as important outcomes of higher HRQoL.

About research

In the current study, researchers interviewed all eligible patients 3 and 12 months after discharge and asked them to complete a questionnaire containing questions about physical and mental health, fatigue levels, and QoL.

The questionnaire collected scores for each participant on six scales focusing on HRQoL, anxiety, depression, stress, and fatigue, as follows:

i) European Quality of Life 5th Dimension 5th Level (EQ-5D-5L),

ii) Generalized Anxiety Disorder-7 (GAD-7),

iii) Patient Health Questionnaire-9 (PHQ-9);

iv) Perceived Stress Scale (PSS-10),

v) Post-Traumatic Symptom Scale 10 (PTSS-10), and

vi) DOES fatigue scale

In addition, researchers assessed clinical vulnerability during 3- and 12-month follow-ups. They presented continuous and categorical variables as medians and percentages, respectively.

result

The team was able to evaluate 27 and 30 ICU patients during 3- and 12-month follow-up, respectively. Similarly, his 35 non-ICU patients and 38 non-ICU patients were followed up for 3 and 12 months, respectively. At both 3 and 12 months post-discharge, the ICU patient showed a decrease in her HRQoL and little improvement in her 1-year status than the non-ICU patient. COVID-19 has most severely compromised the mobility and daily life of affected patients.

Low proportion of non-ICU patients without problems across all five dimensions of EQ-5D-5L, a broadly applicable measure of general HRQoL, and long-term sequelae are common even in non-ICU COVID-19 cases is shown. Surprisingly, all her EQ-5D-5L dimensions were restricted in ICU patients. Fewer than a quarter of her had daily activities, but a third had no mental or physical problems such as pain, movement disorders, depression or anxiety.

Nearly one-fifth of all patients had depression, of which 18% and 20% were non-ICU and ICU patients, respectively. A significant number of patients had severe fatigue and stress. However, some ICU patients had fatigue and anxiety disorders.

PTSD was less common in non-ICU patients, but 10% of COVID-19 ICU patients had suspected PTSD and 23% were at risk. Also, a percentage of ICU patients had higher levels of self-perceived stress than non-ICU patients. Unfortunately, almost all her ICU survivors experienced moderate to high stress levels in the first year after discharge.

Conclusion

Overall, the study data highlighted the complexity of the long-term sequelae of COVID-19 and the need to raise awareness about monitoring the mental health of patients and primary care providers.

In this study, ICU survivors had decreased HRQoL. This is similar to how a meta-analysis explained that acute respiratory distress syndrome (ARDS) can significantly impair her QoL in the long term. Conversely, other types of survivors, such as acute kidney injury survivors, had relatively higher her QoL than age- and sex-matched survivors.

Studies have also demonstrated that lower HRQoL is not an unacceptable outcome. For example, in a study conducted on 1453 ICU survivors, approximately 95% self-reported their EQ-5D index on self-reported summary HRQoL as 0.81. An EQ-5D-index equal to 0.57 was considered unacceptable, but its cutoff value could not be clearly distinguished.

Furthermore, in this study, the authors noted that psychiatric disorders were common, while PTSD or anxiety were not commonly observed. After that, I lived independently at home.