Prevalence and Risk Factor Analysis of Post-Intensive Care Syndrome in Patients with COVID-19 Requiring Mechanical Ventilation: A Multicenter Prospective Observational Study

Abstract

Introduction: Post-intensive care syndrome (PICS) is an emerging problem in critically ill patients and the prevalence and risk factors are unclear in patients with severe coronavirus disease 2019 (COVID-19). This multicenter prospective observational study aimed to investigate the prevalence and risk factors of PICS in ventilated patients with COVID-19 after ICU discharge. Methods: Questionnaires were administered twice in surviving patients with COVID-19 who had required mechanical ventilation, concerning Barthel Index, Short-Memory Questionnaire, and Hospital Anxiety and Depression Scale scores. The risk factors for PICS were examined using a multivariate logistic regression analysis. Results: The first and second PICS surveys were obtained at 5.5 and 13.5 months (mean) after ICU discharge, with 251 and 209 patients completing the questionnaires and with a prevalence of PICS of 58.6% and 60.8%, respectively, along with the highest percentages of cognitive impairment. Delirium (with an odds ratio of (OR) 2.34, 95% CI 1.1–4.9, and p = 0.03) and the duration of mechanical ventilation (with an OR of 1.29, 95% CI 1.05–1.58, and p = 0.02) were independently identified as the risk factors for PICS in the first PICS survey. Conclusion: Approximately 60% of the ventilated patients with COVID-19 experienced persistent PICS, especially delirium, and required longer mechanical ventilation.

Is COVID-19 Infection a Multiorganic Disease? Focus on Extrapulmonary Involvement of SARS-CoV-2

“…Specific inflammatory myositis was reported in 23% of severe COVID-19 [ 43 ]. The prevalence of ICU-acquired weakness, also called ICU-related neuro-myopathy in COVID-19, was reported in 61–75% of patients needing mechanical ventilation [ 52 , 53 ]. This prevalence is higher than that reported in a large series of ventilated patients for other causes [ 54 ].…”

COVID-19 delirium and encephalopathy: Pathophysiology assumed in the first 3 years of the ongoing pandemic

“…COVID-19 patients who left the ICU after intubation showed cognitive decline at the rate of 46.6% at approximately 6 months (as compared to 31.8% in non-COVID patients) and 53.1% at approximately 1 year [ 15 , 16 ].…”

Factors influencing long-term recovery in critically ill COVID-19 survivors: A prospective multicentre cohort study

“…Irrespective of COVID-19 severity, an increasing number of studies report persisting symptoms and delayed long-term complications after acute infection, referred to as post-acute COVID-19 syndrome [12, 13]. Patients surviving critical COVID-19 may thus develop lasting impairment due to both PICS and post-acute COVID-19 [14, 15]. Cross-sectional telephone interviews at 4-6 months after the ICU stay show that critically ill COVID-19 survivors commonly report new disabilities [16].…”