Post-infectious and post-acute sequelae of critically ill adults with COVID-19

Abstract

Background Data on the post-acute and post-infectious complications of patients who have recovered from severe coronavirus disease 2019 (COVID-19) are limited. While studies report that approximately 5–15% of COVID-19 hospitalized patients require intensive care and mechanical ventilation, a substantially higher number need non-invasive ventilation and are subject to prolonged hospitalizations, with long periods of immobility and isolation. The purpose of this study is to describe the post-infectious sequelae of severe viral illness and the post-acute complications of intensive care treatments in critically ill patients who have recovered from severe COVID-19 infection. Methods We performed a retrospective chart review of adult patients initially hospitalized with confirmed COVID-19 infection, who recovered and were transferred to a general medical ward or discharged home between March 15, 2020 and May 15, 2020, dates inclusive, after an intensive care unit (ICU) or high dependency unit (HDU) admission in a designated COVID-19 hospital in the United Arab Emirates. Demographic data, underlying comorbidities, treatment, complications, and outcomes were collected. Descriptive statistical analyses were performed. Results Of 71 patients transferred out of ICU (n = 38, 54%) and HDU (n = 33, 46%), mean age was 48 years (SD, 9.95); 96% men; 54% under age 50. Mean ICU stay was 12.4 days (SD, 5.29), HDU stay was 13.4 days (SD, 4.53). Pre-existing conditions were not significantly associated with developing post-acute complications (Odds Ratio [OR] 1.1, 95% confidence interval [CI] 0.41, 2.93, p = 1.00). Fifty nine percent of patients had complications; myopathy, swallowing impairments, and pressure ulcers were most common. Delirium and confusion were diagnosed in 18% (n = 13); all were admitted to the ICU and required mechanical ventilation. Of note, of all patients studied, 59.2% (n = 42/71) had at least 1 complication, 32.4% (n = 23) had at least 2 complications, and 19.7% (n = 14) suffered 3 or more sequelae. Complications were significantly more common in ICU patients (n = 33/38, 87%), compared to HDU patients (n = 9/33, 27%) (OR 17.6, 95% CI 5.23, 59.21, p <0.05). Conclusion In a subset of critically ill patients who recovered from severe COVID-19 infection, there was considerable short-term post-infectious and post-acute disability. Long-term follow-up of COVID-19 survivors is warranted.

Elevation of neural injury markers in patients with neurologic sequelae after hospitalization for SARS-CoV-2 infection

“…Recently, in patients with COVID-19, astrocytic and neural injury markers have been correlated to COVID-19 severity but failed to predict subsequent long-term neurological outcomes (Kanberg et al, 2021). However, that study did not show a correlation of neurological outcome symptoms with disease severity which has been shown in several trials (Hopkins and Brett, 2005;Hopkins and Jackson, 2006;Herridge et al, 2016;Ibrahim et al, 2021). While it is clear that ICU level care and disease severity (likely associated with higher levels of peripheral inflammation and hypoxemia) in both patients with COVID-19 and pre-COVID historical patients is associated with both neurological sequelae and elevated brain injury, infection with SARS-CoV2 infection itself appears to markedly increase the likelihood of developing subsequent neurological symptoms.…”

Remote Assessment of Quality of Life and Functional Exercise Capacity in a Cohort of COVID-19 Patients One Year after Hospitalization (TELECOVID)

“…Other cohort studies reporting outcomes at 4 to 6 months found inconclusive results related to the impact of the type of ward patients were admitted to [8,11]. It is well known that a stay in ICU is related to a higher prevalence of muscle weakness and exercise limitation at hospital discharge [6,36,37]. However, the patients admitted to ICU in our sample were younger and had a lower level of frailty at baseline, suggesting that the poor outcomes observed at discharge were reversible, in contrast with what observed for patients with previous frailty.…”

“…HRQOL was assessed using the French version of the SF-36 survey, which is composed of one item related to changes in health during the previous year and 35 items within 8 categories: (1) physical functioning, (2) role limitations due to physical health, (3) pain, (4) general health, (5) emotional well-being, (6) role limitations due to emotional problems, (7) vitality, and (8) social functioning. The total score ranges from 0 to 100, with a higher score indicating a better health status [21,22].…”

“…A small proportion of patients (5-15%) require intensive care; however, a large proportion require prolonged hospitalization, which can lead to immobility and isolation [3][4][5]. These patients may return home with a wide spectrum of sequelae [6,7]. Follow-up studies have reported that most patients have post-discharge and/or post-COVID symptoms, including short-and medium-term respiratory complications, as well as chronic fatigue, muscle weakness, and anxiety or depression, all of which may reduce their quality of life [8][9][10][11].…”

Coronavirus Pneumonia: Outcomes and Characteristics of Patients in an Inner-City Area after 3 Months of Infection

“…In the Long-COVID syndrome, coughing and dyspnea are prominent, lasting for several months, with coughing been present in 15% to 42% of patients [7,[11][12][13]. The supplemental oxygen requirement for post-acute COVID-19 infection ranges from no requirements to up to 50% of patients being discharged on oxygen, and this wide variation is likely due to the time-frame of the study, as most patients will not require oxygen after 4 to 6 months post-infection [14,15]. Factors reported to be predictive of post-COVID syndrome are female sex, severity of acute infection, and the presence of respiratory comorbid conditions [12,13,16].…”