Post-intensive care syndrome after a critical COVID-19: cohort study from a Belgian follow-up clinic

Abstract

Purpose Many patients with coronavirus disease 2019 (COVID-19) required critical care. Mid-term outcomes of the survivors need to be assessed. The objective of this single-center cohort study was to describe their physical, cognitive, psychological, and biological outcomes at 3 months following intensive care unit (ICU)-discharge (M3). Patients and methods All COVID-19 adults who survived an ICU stay ≥ 7 days and attended the M3 consultation at our multidisciplinary follow-up clinic were involved. They benefited from a standardized assessment, addressing health-related quality of life (EQ-5D-3L), sleep disorders (PSQI), and the three principal components of post-intensive care syndrome (PICS): physical status (Barthel index, handgrip and quadriceps strength), mental health disorders (HADS and IES-R), and cognitive impairment (MoCA). Biological parameters referred to C-reactive protein and creatinine. Results Among the 92 patients admitted to our ICU for COVID-19, 42 survived a prolonged ICU stay and 32 (80%) attended the M3 follow-up visit. Their median age was 62 [49–68] years, 72% were male, and nearly half received inpatient rehabilitation following ICU discharge. At M3, 87.5% (28/32) had not regained their baseline level of daily activities. Only 6.2% (2/32) fully recovered, and had normal scores for the three MoCA, IES-R and Barthel scores. The main observed disorders were PSQI > 5 (75%, 24/32), MoCA < 26 (44%, 14/32), Barthel < 100 (31%, 10/32) and IES-R ≥ 33 (28%, 9/32). Combined disorders were observed in 13/32 (40.6%) of the patients. The EQ-5D-3L visual scale was rated at 71 [61–80]. A quarter of patients (8/32) demonstrated a persistent inflammation based on CRP blood level (9.3 [6.8–17.7] mg/L). Conclusion The burden of severe COVID-19 and prolonged ICU stay was considerable in the present cohort after 3 months, affecting both functional status and biological parameters. These data are an argument on the need for closed follow-up for critically ill COVID-19 survivors.

Analysis of mental and physical disorders associated with COVID-19 in online health forums: a natural language processing study

“…Follow-up data in more recent studies has highlighted the potential for COVID-19 to be associated with prolonged, multisystem involvement associated with significant disability, 22 with considerable reduction in functioning and quality of life among individuals who have received intensive care treatment. 23 A significant proportion of people who have received intensive care treatment for COVID-19 have post-intensive care syndrome characterised by physical and cognitive impairments and problems with mental health. 24 This could explain the increasing rates of threads related to intensive care treatment due to forum users’ concerns of the potential need for intensive care treatment, raising questions about family members or friends currently receiving intensive care treatment, or in relation to problems faced after being discharged from the intensive care setting.…”

Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review

“…There are already expressed fears that post-COVID-19 PICS will overwhelm healthcare facilities designed and available for post-ICU rehabilitation [130]. Multiple centers are creating multidisciplinary programs for the post-COVID-19 population [131,132]. Authors report that the physical, psychological and cognitive impairments observed in post-COVID-19 ICU survivors were comparable to those observed in non-COVID-19 patients [133].…”

Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study

“…Moreover, patients who underwent ICU admission for COVID-19 related ARDS (C-ARDS) may also experience post-intensive care syndrome (PICS), which eventually overlaps other symptoms related to COVID-19 itself [9].…”