Association between acute disease severity and one-year quality of life among post-hospitalisation COVID-19 patients: Coalition VII prospective cohort study

Abstract

Purpose To assess the association between acute disease severity and 1-year quality of life in patients discharged after hospitalisation due to coronavirus disease 2019 (COVID-19). Methods We conducted a prospective cohort study nested in 5 randomised clinical trials between March 2020 and March 2022 at 84 sites in Brazil. Adult post-hospitalisation COVID-19 patients were followed for 1 year. The primary outcome was the utility score of EuroQol five-dimension three-level (EQ-5D-3L). Secondary outcomes included all-cause mortality, major cardiovascular events, and new disabilities in instrumental activities of daily living. Adjusted generalised estimating equations were used to assess the association between outcomes and acute disease severity according to the highest level on a modified ordinal scale during hospital stay (2: no oxygen therapy; 3: oxygen by mask or nasal prongs; 4: high-flow nasal cannula oxygen therapy or non-invasive ventilation; 5: mechanical ventilation). Results 1508 COVID-19 survivors were enrolled. Primary outcome data were available for 1156 participants. At 1 year, compared with severity score 2, severity score 5 was associated with lower EQ-5D-3L utility scores (0.7 vs 0.84; adjusted difference, − 0.1 [95% CI − 0.15 to − 0.06]); and worse results for all-cause mortality (7.9% vs 1.2%; adjusted difference, 7.1% [95% CI 2.5%–11.8%]), major cardiovascular events (5.6% vs 2.3%; adjusted difference, 2.6% [95% CI 0.6%–4.6%]), and new disabilities (40.4% vs 23.5%; adjusted difference, 15.5% [95% CI 8.5%–22.5]). Severity scores 3 and 4 did not differ consistently from score 2. Conclusions COVID-19 patients who needed mechanical ventilation during hospitalisation have lower 1-year quality of life than COVID-19 patients who did not need mechanical ventilation during hospitalisation. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06953-1.

Comparing severe COVID-19 outcomes of first and second/third waves: a prospective single-centre cohort study of health-related quality of life and pulmonary outcomes 6 months after infection

“…In line with this, severity of disease has in previous literature been reported to be associated with more remaining health related symptoms at follow-up 9. As previously reported about the first wave survivors in the cohort, their quality of life was reduced compared with the general Swedish population,8 also consistent with data from other populations 31…”

What Role Does Microthrombosis Play in Long COVID?

“…Patients requiring mechanical ventilation may also be at a greater risk for lower health-related quality of life and worse mortality. 61 Blanco et al 62 examined the respiratory function of severe cases of PASC and reported that diffusion deficit (DLCO [diffusing capacity for carbon monoxide] <80%) was present 100 days after hospital discharge. Other than lung function defects, multiple sequelae, including cardiac injury, correlate with initial disease severity and improve over time in most patients.…”

Two‐ and 3‐year outcomes in convalescent individuals with COVID‐19: A prospective cohort study

“…Over the first 3 years of the pandemic, hospital admissions and mortality among people infected with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) have decreased owing to the availability of effective vaccines and therapies 2 . With the growing number of patients recovering from COVID‐19, attention has focused on multi‐system symptoms and quality of life in convalescent individuals 3–5 . To date, emerging epidemiological and clinical evidence has revealed persistent health issues following COVID‐19, which are referred to as long COVID or post‐COVID‐19 condition 6,7 .…”

“…2 With the growing number of patients recovering from COVID-19, attention has focused on multi-system symptoms and quality of life in convalescent individuals. [3][4][5] To date, emerging epidemiological and clinical evidence has revealed persistent health issues following COVID-19, which are referred to as long COVID or post-COVID-19 condition. 6,7 However, the current understanding of long COVID remains limited, and there is no general consensus on its long-term consequences.…”