Physical, cognitive and mental health outcomes in 1-year survivors of COVID-19-associated ARDS

Latronico, Nicola; Peli, Elena; Calza, Stefano; Rodella, Filippo; Novelli, Maria Paola; Cella, Andrea; Marshall, John C.; Needham, Dale M.; Rasulo, Frank; Piva, Simone

doi:10.1136/thoraxjnl-2021-218064

Cited by 93 publications

(101 citation statements)

References 14 publications

(15 reference statements)

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“…When examining trajectories of recovery from 6 to 12-months, the majority of patients did not have improvements in functional status (mRS) or activities of daily living (Barthel Index), however, there were significant improvements in cognition and anxiety scores between 6-month and 12-month follow-up, and substantial proportions of patients had non-significant improvements in fatigue, sleep and depression scores. While some studies have reported that 45%-77% of patients have at least one symptom 12-months after COVID hospitalization 7, 8, 26 , we identified higher rates of objective abnormalities in functional, cognitive and self-reported patient-centered outcomes. In contrast to subjective symptom-based data, our findings highlight that standardized metrics may unmask disability or psychiatric symptoms of which patients may not even be cognizant.…”

Section: Discussioncontrasting

confidence: 66%

“…In contrast to subjective symptom-based data, our findings highlight that standardized metrics may unmask disability or psychiatric symptoms of which patients may not even be cognizant. A smaller longitudinal study of 51 patients assessed at 12-months post-COVID ARDS (adult respiratory distress syndrome) utilized standardized batteries and identified severe fatigue in 26% of patients and abnormal 6-minute walk test in 36% of patients 26 , though only 7/51 (16%) of patients had an abnormal MoCA score (<25). Because this study included only patients who were capable of in person follow-up, the most severely affected patients were likely not captured.…”

Section: Discussionmentioning

confidence: 99%

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Trajectories of Neurological Recovery 12 Months after Hospitalization for COVID-19: A Prospective Longitudinal Study

Frontera

Yang

medircherla

et al. 2022

Preprint

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Background/Objectives: Little is known about trajectories of recovery 12-months after hospitalization for severe COVID. Methods: We conducted a prospective, longitudinal cohort study of patients with and without neurological complications during index hospitalization for COVID-19 from March 10, 2020-May 20, 2020. Phone follow-up batteries were performed at 6- and 12-months post-COVID symptom onset. The primary 12-month outcome was the modified Rankin Scale (mRS) comparing patients with or without neurological complications using multivariable ordinal analysis. Secondary outcomes included: activities of daily living (Barthel Index), telephone Montreal Cognitive Assessment (t-MoCA) and Neuro-QoL batteries for anxiety, depression, fatigue and sleep. Changes in outcome scores from 6 to 12-months were compared using non-parametric paired-samples sign test. Results: Twelve-month follow-up was completed in N=242 patients (median age 65, 64% male, 34% intubated during hospitalization) and N=174 completed both 6- and 12-month follow-up. At 12-months 197/227 (87%) had ≥1 abnormal metric: mRS>0 (75%), Barthel<100 (64%), t-MoCA≤18 (50%), high anxiety (7%), depression (4%), fatigue (9%) and poor sleep (10%). 12-month mRS scores did not differ significantly among those with (N=113) or without (N=129) neurological complications during hospitalization after adjusting for age, sex, race, pre-COVID mRS and intubation status (adjusted OR 1.4, 95% CI0.8-2.5), though those with neurological complications had higher fatigue scores (T-score 47 vs 44, P=0.037). Significant improvements in outcome trajectories from 6- to 12-months were observed in t-MoCA scores (56% improved, median difference 1 point, P=0.002), and Neuro-QoL anxiety scores (45% improved, P=0.003). Non-significant improvements occurred in fatigue, sleep and depression scores in 48%, 48% and 38% of patients, respectively. Barthel and mRS scores remained unchanged between 6 and 12-months in >50% of patients. Discussion: At 12-months post-hospitalization for severe COVID, 87% of patients had ongoing abnormalities in functional, cognitive or Neuro-QoL metrics and abnormal cognition persisted in 50% of patients without a prior history of dementia/cognitive abnormality. Only fatigue severity differed significantly between patients with or without neurological complications during index hospitalization. However, significant improvements in cognitive (t-MoCA) and anxiety (Neuro-QoL) scores occurred in 56% and 45% of patients, respectively, between 6- to 12-months. These results may not be generalizable to those with mild/moderate COVID.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Trajectories of Neurological Recovery 12 Months after Hospitalization for COVID-19: A Prospective Longitudinal Study

Frontera

Yang

medircherla

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…However, a small-scale cohort study in Germany [32] showed that between 5 months and 12 months post COVID, the prevalence of hair loss decreased significantly from 26.1% to 10.4%, but the prevalence of fatigue and dyspnoea increased (from 41.7% to 53.1% and from 27.1% to 37.5%, respectively). Another small-scale Italian cohort study of survivors after intensive care unit discharge [26] found that cognitive impairment significantly improved (from 28% at 3 months to 16% at 12 months), but no significant changes were observed for severe fatigue, depression, anxiety, insomnia, and PTSD symptoms.…”

Section: Discussionmentioning

confidence: 98%

Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms

et al. 2022

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Emerging evidence has shown that COVID-19 survivors could suffer from persistent symptoms. However, it remains unclear whether these symptoms persist over the longer term. This study aimed to systematically synthesise evidence on post-COVID symptoms persisting for at least 12 months. We searched PubMed and Embase for papers reporting at least one-year follow-up results of COVID-19 survivors published by 6 November 2021. Random-effects meta-analyses were conducted to estimate pooled prevalence of specific post-COVID symptoms. Eighteen papers that reported one-year follow-up data from 8591 COVID-19 survivors were included. Fatigue/weakness (28%, 95% CI: 18–39), dyspnoea (18%, 95% CI: 13–24), arthromyalgia (26%, 95% CI: 8–44), depression (23%, 95% CI: 12–34), anxiety (22%, 95% CI: 15–29), memory loss (19%, 95% CI: 7–31), concentration difficulties (18%, 95% CI: 2–35), and insomnia (12%, 95% CI: 7–17) were the most prevalent symptoms at one-year follow-up. Existing evidence suggested that female patients and those with more severe initial illness were more likely to suffer from the sequelae after one year. This study demonstrated that a sizeable proportion of COVID-19 survivors still experience residual symptoms involving various body systems one year later. There is an urgent need for elucidating the pathophysiologic mechanisms and developing and testing targeted interventions for long-COVID patients.

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“…The prevalence of psychiatric symptoms in the months following COVID-19 has been reported in several studies based on self-report questionnaires, which provided follow-up for 14 days to 6 months. They consistently reported a high prevalence of insomnia (31–54%), anxiety symptoms (5–46%), depressive symptoms (9–42%) and post-traumatic stress symptoms (10–57%) ( supplementary table S1 ) [ 7 , 8 , 12 , 48 – 69 ]. In the COMEBAC study cohort, we reported insomnia in 54% of patients, anxiety symptoms in 31%, depressive symptoms in 22% and post-traumatic stress symptoms in 14% at 4 months after hospitalisation for COVID-19 [ 7 ].…”

Section: Psychiatric Symptoms and Disordersmentioning

confidence: 99%

Post-acute COVID-19 syndrome

et al. 2022

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Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the coronavirus disease 2019 (COVID-19) pandemic that has resulted in millions of deaths and a major strain on health systems worldwide. Medical treatments for COVID-19 (anticoagulants, corticosteroids, anti-inflammatory drugs, oxygenation therapy and ventilation) and vaccination have improved patient outcomes. The majority of patients will recover spontaneously or after acute-phase management, but clinicians are now faced with long-term complications of COVID-19 including a large variety of symptoms, defined as “post-acute COVID-19 syndrome”. Most studies have focused on patients hospitalised for severe COVID-19, but acute COVID-19 syndrome is not restricted to these patients and exists in outpatients. Given the diversity of symptoms and the high prevalence of persistent symptoms, the management of these patients requires a multidisciplinary team approach, which will result in the consumption of large amounts of health resources in the coming months. In this review, we discuss the presentation, prevalence, pathophysiology and evolution of respiratory complications and other organ-related injuries associated with post-acute COVID-19 syndrome.

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Physical, cognitive and mental health outcomes in 1-year survivors of COVID-19-associated ARDS

Cited by 93 publications

References 14 publications

Trajectories of Neurological Recovery 12 Months after Hospitalization for COVID-19: A Prospective Longitudinal Study

Trajectories of Neurological Recovery 12 Months after Hospitalization for COVID-19: A Prospective Longitudinal Study

Long-Term Sequelae of COVID-19: A Systematic Review and Meta-Analysis of One-Year Follow-Up Studies on Post-COVID Symptoms

Post-acute COVID-19 syndrome

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