Survival After Severe COVID-19: Long-Term Outcomes of Patients Admitted to an Intensive Care Unit

Neville, Thanh; Tseng, Chi‐Hong; Gonzalez, Cynthia A; Chen, Lucia; Hong, Aayoung; Yamamoto, Myrtle; Santoso, Laura; Kung, Alina; Schwab, Kristin; Chang, Shoou‐Yuh; Qadir, Nida; Wang, Tisha; Wenger, Neil S.

doi:10.1177/08850666221092687

Cited by 16 publications

(27 citation statements)

References 60 publications

(62 reference statements)

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“… 6 Multiple national and international collaborations have reported outcome data in critically ill patients, 7 , 8 , 9 including long‐term functional outcomes. 10 …”

Section: Introductionmentioning

confidence: 99%

“…6 Multiple national and international collaborations have reported outcome data in critically ill patients, [7][8][9] including long-term functional outcomes. 10 Our objectives were (a) to evaluate factors on ICU admission associated with 90-day mortality and (b) to describe factors during the ICU stay associated with functional outcomes at 90 days. We hypothesised that high age, body mass index (BMI) and ICU burden were associated with increased 90-day mortality, longer ICU stay and worse functional outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, the impact of health care burden on clinical outcomes has been addressed and may have played a significant role at the height of the pandemic 6 . Multiple national and international collaborations have reported outcome data in critically ill patients, 7–9 including long‐term functional outcomes 10 …”

Section: Introductionmentioning

confidence: 99%

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Intensive care unit burden is associated with increased mortality in critically ill COVID‐19 patients

Didriksson

Leffler

Spångfors

et al. 2022

Acta Anaesthesiol Scand

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Background Traditional models to predict intensive care outcomes do not perform well in COVID‐19. We undertook a comprehensive study of factors affecting mortality and functional outcome after severe COVID‐19. Methods In this prospective multicentre cohort study, we enrolled laboratory‐confirmed, critically ill COVID‐19 patients at six ICUs in the Skåne Region, Sweden, between May 11, 2020, and May 10, 2021. Demographics and clinical data were collected. ICU burden was defined as the total number of ICU‐treated COVID‐19 patients in the region on admission. Surviving patients had a follow‐up at 90 days for assessment of functional outcome using the Glasgow Outcome Scale‐Extended (GOSE), an ordinal scale (1–8) with GOSE ≥5 representing a favourable outcome. The primary outcome was 90‐day mortality; the secondary outcome was functional outcome at 90 days. Results Among 498 included patients, 74% were male with a median age of 66 years and a median body mass index (BMI) of 30 kg/m 2 . Invasive mechanical ventilation was employed in 72%. Mortality in the ICU, in‐hospital and at 90 days was 30%, 38% and 39%, respectively. Mortality increased markedly at age 60 and older. Increasing ICU burden was independently associated with a two‐fold increase in mortality. Higher BMI was not associated with increased mortality. Besides age and ICU burden, smoking status, cortisone use, P a CO 2 >7 kPa, and inflammatory markers on admission were independent factors of 90‐day mortality. Lower GOSE at 90 days was associated with a longer stay in the ICU. Conclusion In critically ill COVID‐19 patients, the 90‐day mortality was 39% and increased considerably at age 60 or older. The ICU burden was associated with mortality, whereas a high BMI was not. A longer stay in the ICU was associated with unfavourable functional outcomes at 90 days.

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“… 6 Multiple national and international collaborations have reported outcome data in critically ill patients, 7 , 8 , 9 including long‐term functional outcomes. 10 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intensive care unit burden is associated with increased mortality in critically ill COVID‐19 patients

Didriksson

Leffler

Spångfors

et al. 2022

Acta Anaesthesiol Scand

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“…11,20,29 A study that looked at the long-term outcomes of patients who needed ICU admission for severe COVID-19 found that the long-term effects of severe COVID-19 lasted more than six months. 34 Similarly, a 12-month study found that a chest CT scan in acute COVID-19 correlates with pulmonary function and respiratory symptoms after SARS-CoV-2 infection. 35 Obesity, hypertension, diabetes mellitus, and the presence of any chronic illness were all statistically significant predictors of long COVID.…”

Section: Discussionmentioning

confidence: 95%

Burden, Causation, and Particularities of long-COVID in African populations: A rapid systematic review

Nyasulu

Tamuzi

Erasmus

2023

Preprint

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Background: The global estimated prevalence of long COVID-19 is 43%, and the most common symptoms found globally are fatigue, confusion, or lack of confusion, and dyspnea, with prevalence rates of 23%, 14%, and 13%, respectively. However, long COVID still lacks an overall review in African populations. The aim of this review was to determine the prevalence of long COVID, its most common symptoms, comorbidities, and pathophysiological mechanisms. Methods: A systematic review of long COVID in African populations was conducted. The random effects model was used to calculate the pooled prevalence rates (95% CI). If the results could not be pooled, a narrative synthesis was performed. Results: We included 14 studies from 7 African countries, totaling 6,030 previously SARS-CoV-2 infected participants and 2,954 long COVID patients. Long COVID had a pooled prevalence of 41% [26%-56%]. Fatigue, dyspnea, and confusion or lack of concentration were the most common symptoms, with prevalence rates (95% CI) of 41% [26%-56%], 25% [12%-38%], and 40% [12%-68%], respectively. Long COVID was associated with advanced age, being female, more than three long COVID symptoms in the acute phase, initial fatigue and dyspnea, post-recovery stress, sadness, and sleep disturbances, and loss of appetite at symptoms onset, mild, moderate, and severe, pre-existing obesity, hypertension, diabetes mellitus, and the presence of any chronic illness (P ≤0.05). According to our review, high micro clot and platelet poor plasma (PPP) viscosity explain the pathophysiology of long COVID. Conclusion: Long COVID prevalence in Africa was comparable to the global prevalence. However, the prevalence of the most common symptoms was higher in Africa. Comorbidities associated with long COVID may lead to additional complications in African populations due to hypercoagulation and thrombosis.

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“…12 Intensive care services were stretched by unprecedented demand, acute staff shortages and high levels of personal protective equipment. 13 Data from previous infective outbreaks, 14 suggest that clinicians may witness an increased incidence of post-ICU psychopathology, following the pandemic. 15 …”

Section: Introductionmentioning

confidence: 99%

A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19

Bates

Golding

Rushbrook

et al. 2022

Journal of the Intensive Care Society

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Background: Approximately 50% of intensive care survivors experience persistent psychological symptoms. Eye-movement desensitisation and reprocessing (EMDR) is a widely recommended trauma-focussed psychological therapy, which has not been investigated systematically in a cohort of intensive care survivors: We therefore conducted a randomised pilot feasibility study of EMDR, using the Recent Traumatic Episode Protocol (R-TEP), to prevent psychological distress in intensive care survivors. Findings will determine whether it would be possible to conduct a fully-powered clinical effectiveness trial and inform trial design. Method: We aimed to recruit 26 patients who had been admitted to intensive care for over 24 h with COVID-19 infection. Consenting participants were randomised (1:1) to receive either usual care plus remotely delivered EMDR R-TEP or usual care alone (controls). The primary outcome was feasibility. We also report factors related to safety and symptom changes in post-traumatic stress disorder, (PTSD) anxiety and depression. Results: We approached 51 eligible patients, with 26 (51%) providing consent. Intervention adherence (sessions offered/sessions completed) was 83%, and 23/26 participants completed all study procedures. There were no attributable adverse events. Between baseline and 6-month follow-up, mean change in PTSD score was −8 (SD = 10.5) in the intervention group versus +0.75 (SD = 15.2) in controls ( p = 0.126). There were no significant changes to anxiety or depression. Conclusion: Remotely delivered EMDR R-TEP met pre-determined feasibility and safety objectives. Whilst we achieved group separation in PTSD symptom change, we have identified a number of protocol refinements that would improve the design of a fully powered, multi-centre randomised controlled trial, consistent with currently recommended rehabilitation clinical pathways. Trial registration: ClinicalTrials.gov: NCT04455360.

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Survival After Severe COVID-19: Long-Term Outcomes of Patients Admitted to an Intensive Care Unit

Cited by 16 publications

References 60 publications

Intensive care unit burden is associated with increased mortality in critically ill COVID‐19 patients

Intensive care unit burden is associated with increased mortality in critically ill COVID‐19 patients

Burden, Causation, and Particularities of long-COVID in African populations: A rapid systematic review

A randomised pilot feasibility study of eye movement desensitisation and reprocessing recent traumatic episode protocol, to improve psychological recovery following intensive care admission for COVID-19

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