Long term outcomes of critically ill COVID-19 pneumonia patients: early learning

McCue, Claire; Cowan, Richard; Quasim, Tara; Puxty, Kathryn; McPeake, Joanne

doi:10.1007/s00134-020-06313-x

Cited by 32 publications

(32 citation statements)

References 6 publications

(7 reference statements)

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“…Substantial morbidity and mortality have been reported to accompany PICS. Moreover, the prevalence and severity of PICS among COVID-19 survivors may be greater than in general sepsis cohorts because the pandemic has overwhelmed ICUs in many parts of the world and hindered optimal care (30,145,(147)(148)(149)(150).…”

Section: Post-icu Complicationsmentioning

confidence: 99%

Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19

et al. 2021

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More than one year since its emergence, corona virus disease 2019 (COVID-19) is still looming large with a paucity of treatment options. To add to this burden, a sizeable subset of patients who have recovered from acute COVID-19 infection have reported lingering symptoms, leading to significant disability and impairment of their daily life activities. These patients are considered to suffer from what has been termed as “chronic” or “long” COVID-19 or a form of post-acute sequelae of COVID-19, and patients experiencing this syndrome have been termed COVID-19 long-haulers. Despite recovery from infection, the persistence of atypical chronic symptoms, including extreme fatigue, shortness of breath, joint pains, brain fogs, anxiety and depression, that could last for months implies an underlying disease pathology that persist beyond the acute presentation of the disease. As opposed to the direct effects of the virus itself, the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is believed to be largely responsible for the appearance of these lasting symptoms, possibly through facilitating an ongoing inflammatory process. In this review, we hypothesize potential immunological mechanisms underlying these persistent and prolonged effects, and describe the multi-organ long-term manifestations of COVID-19.

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Section: Post-icu Complicationsmentioning

confidence: 99%

Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19

et al. 2021

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“…We also summarized all the current data regarding persistent symptoms after acute COVID-19 (see Table 3). According to the available evidence [3][4][5][6][7][8][18][19][20][21][22][23][24][25][26], the most frequent symptoms during follow-up are dyspnea and fatigue. Six studies evaluated pulmonary function, detecting a decrease in DL CO with a normal FEV1/FVC in the global post-COVID-19 population at short-term follow-up [5][6][7][8]24].…”

Section: Summary Of Published Evidencementioning

confidence: 99%

“…The high rate of post-COVID-19 symptomatic patients is in agreement with alternative coronavirus outbreaks. Although several studies have explored the symptom burden [3][4][5][6][7][8][18][19][20][21][22][23][24][25][26], similarly reporting a substantial proportion of patients with persistent dyspnea and fatigue, limited information exists regarding exercise capacity [5][6][7][8]24]. Two prior studies have reported a decreased 6-MWT distance among survivors [5,21,24].…”

Section: Rationale For Post-covid-19 Symptom Persistencementioning

confidence: 99%

Exercise Ventilatory Inefficiency in Post-COVID-19 Syndrome: Insights from a Prospective Evaluation

Alonso

Ybarra-Falcón

García-Gómez

et al. 2021

JCM

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Introduction: Coronavirus disease 2019 (COVID-19) is a systemic disease characterized by a disproportionate inflammatory response in the acute phase. This study sought to identify clinical sequelae and their potential mechanism. Methods: We conducted a prospective single-center study (NCT04689490) of previously hospitalized COVID-19 patients with and without dyspnea during mid-term follow-up. An outpatient group was also evaluated. They underwent serial testing with a cardiopulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis, and quality of life questionaries. Results: Patients with dyspnea (n = 41, 58.6%), compared with asymptomatic patients (n = 29, 41.4%), had a higher proportion of females (73.2 vs. 51.7%; p = 0.065) with comparable age and prevalence of cardiovascular risk factors. There were no significant differences in the transthoracic echocardiogram and pulmonary function test. Patients who complained of persistent dyspnea had a significant decline in predicted peak VO2 consumption (77.8 (64–92.5) vs. 99 (88–105); p < 0.00; p < 0.001), total distance in the six-minute walking test (535 (467–600) vs. 611 (550–650) meters; p = 0.001), and quality of life (KCCQ-23 60.1 ± 18.6 vs. 82.8 ± 11.3; p < 0.001). Additionally, abnormalities in CPET were suggestive of an impaired ventilatory efficiency (VE/VCO2 slope 32 (28.1–37.4) vs. 29.4 (26.9–31.4); p = 0.022) and high PETCO2 (34.5 (32–39) vs. 38 (36–40); p = 0.025). Interpretation: In this study, >50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Our findings suggest a potential ventilation/perfusion mismatch or hyperventilation syndrome.

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“…Hospital mortality in patients admitted to US hospitals during the first pandemic was 9.6% [ 2 ]. Short- and long-term morbidity associated with COVID-19 are also significant [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Tocilizumab in COVID-19: a meta-analysis, trial sequential analysis, and meta-regression of randomized-controlled trials

et al. 2021

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Purpose Interleukin-6 (IL-6) levels discriminate between patients with mild and severe COVID-19, making IL-6 inhibition an attractive therapeutic strategy. We conducted a systematic review, meta-analysis, trial sequential analysis (TSA), and meta-regression of randomized-controlled trials to ascertain the benefit of IL-6 blockade with tocilizumab for COVID-19. Methods We included randomized-controlled trials (RCTs) allocating patients with COVID-19 to tocilizumab. Our control group included standard care or placebo. Trials co-administering other pharmacological interventions for COVID-19 were not excluded. Primary outcome was 2830day mortality. Secondary outcomes included progression-to-severe disease defined as need for mechanical ventilation, intensive-care unit (ICU) admission, or a composite. Results We identified 10 RCTs using tocilizumab, 9 of which reported primary outcome data (mortality), recruiting 6493 patients with 3358 (52.2%) allocated to tocilizumab. Tocilizumab may be associated with an improvement in mortality (24.4% vs. 29.0%; OR 0.87 [0.741.01]; p =0.07; I 2 =10%; TSA adjusted CI 0.661.14). Meta-regression suggested a relationship between treatment effect and mortality risk, with benefit at higher levels of risk (logOR vs %risk beta=0.018 [0.037 to 0.002]; p =0.07). Tocilizumab did reduce the need for mechanical ventilation and was associated with a benefit in the composite secondary outcome but did not reduce ICU admission. Conclusions For hospitalized COVID-19 patients, there is some evidence that tocilizumab use may be associated with a short-term mortality benefit, but further high-quality data are required. Its benefits may also lie in reducing the need for mechanical ventilation. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06416-z.

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Long term outcomes of critically ill COVID-19 pneumonia patients: early learning

Cited by 32 publications

References 6 publications

Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19

Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19

Exercise Ventilatory Inefficiency in Post-COVID-19 Syndrome: Insights from a Prospective Evaluation

Tocilizumab in COVID-19: a meta-analysis, trial sequential analysis, and meta-regression of randomized-controlled trials

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