Background Understanding the long-term sequelae of severe COVID-19 remains limited, particularly in the United States. Objective To examine long-term outcomes of patients who required intensive care unit (ICU) admission for severe COVID-19. Design, Patients, and Main Measures This is a prospective cohort study of patients who had severe COVID-19 requiring an ICU admission in a two-hospital academic health system in Southern California. Patients discharged alive between 3/21/2020 and 12/31/2020 were surveyed approximately 6 months after discharge to assess health-related quality of life using Patient-Reported Outcomes Measurement Information System (PROMIS®)-29 v2.1, post-traumatic stress disorder (PTSD) and loneliness scales. A preference-based health utility score (PROPr) was estimated using 7 PROMIS domain scores. Patients were also asked their attitude about receiving aggressive ICU care. Key Results Of 275 patients admitted to the ICU for severe COVID-19, 205 (74.5%) were discharged alive and 132 (64%, median age 59, 46% female) completed surveys a median of 182 days post-discharge. Anxiety, depression, fatigue, sleep disturbance, ability to participate in social activities, pain interference, and cognitive function were not significantly different from the U.S. general population, but physical function (44.2, SD 11.0) was worse. PROPr mean score of 0.46 (SD 0.30, range −0.02 to 0.96 [<0 is worse than dead and 1 represents perfect health]) was slightly lower than the U.S. general population, with an even distribution across the continuum. Poor PROPr was associated with chronic medical conditions and receipt of life-sustaining treatments, but not demographics or social vulnerability. PTSD was suspected in 20% and loneliness in 29% of patients. Ninety-eight percent of patients were glad they received life-saving treatment. Conclusion Most patients who survive severe COVID-19 achieve positive outcomes, with health scores similar to the general population at 6 months post-discharge. However, there is marked heterogeneity in outcomes with a substantial minority reporting severely compromised health.
INTRODUCTION:The long-term mental health impact of severe COVID-19 is unknown. Characterizing the psychological effects of severe COVID-19 is necessary in order to anticipate post-discharge needs and optimize recovery after admission. METHODS:This is a prospective cohort study of adult patients admitted to the intensive care unit (ICU) due to COVID-19 at two academic medical centers in Los Angeles and discharged between March 1, 2020 and December 31, 2020. Patients and caregivers received telephone calls asking them to complete mailed surveys three to six months after hospital discharge. The survey included the Patient-Reported Outcomes Measurement Information System (PROMIS®)-29 Profile v2.1 and Cognitive Function Short Form 8a V2.0 measures, and the UCLA Loneliness Scale. PROMIS scales are scored on a T-score metric (mean of 50 in the U.S. general population) with higher score indicating higher severity. The UCLA Loneliness Scale ranges from 3-9; scores 3-5 are interpreted as not lonely and 6-9 lonely. The survey also assessed satisfaction with receiving aggressive life-sustaining treatment.
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