Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors

Abstract

Rationale Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre–COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94–2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28–1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% ( P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre–COVID-19 status.

The effectiveness of postacute intensive rehabilitation on severe COVID‐19 patients: A case‐control study

“…For instance, earlier research reported a higher rate of muscle mass and strength reduction in COVID‐19 patients than in other acutely ill individuals 8 . Such findings imply a unique recovery trajectory for COVID‐19 patients, diverging from those of other critically ill patients 2,7 …”

“…Coronavirus Disease 2019 (COVID‐19) can cause multiorgan failure and longer‐term consequences, particularly in patients requiring in‐hospital care 1–4 . Studies indicate that approximately 60% of these patients have persistent symptoms—commonly called “long COVID”—such as fatigue, breathlessness, and joint pain 5–7 .…”

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Coronavirus Disease 2019 (COVID-19) can cause multiorgan failure and longer-term consequences, particularly in patients requiring inhospital care. [1][2][3][4] Studies indicate that approximately 60% of these patients have persistent symptoms-commonly called "long COVID"-such as fatigue, breathlessness, and joint pain. [5][6][7] These long-term effects hinder a smooth transition back to independent living, which encompasses challenges for performing essential selfcare activities.

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“…recovery trajectory for COVID-19 patients, diverging from those of other critically ill patients. 2,7 Evidence shows that postacute intensive rehabilitation can help these patients restore function, avoid hospital readmissions, and improve satisfaction with received care. [3][4][5] Despite such potential benefits, the characteristics of postacute care in patients who have experienced COVID-19 compared to those with other well-known respiratory infections, such as pneumonia caused by influenza or bacterial pathogens, remain unclear.…”

Better but Not Well: Disability, Frailty, and Cognitive Impairment One Year after COVID-19 Critical Illness

“…In this issue of AnnalsATS , Taniguchi and colleagues (pp. 289–295 ) present a prospective cohort study of 428 critically ill COVID-19 survivors in Brazil and report on longitudinal recovery trajectories of a wide range of clinical outcomes ( 5 ). Expanding on their prior report describing increased rates of frailty and disability at 90 days after hospital discharge ( 6 ), this new study extends serial assessments of frailty and disability as well as cognitive impairment over 12 months of follow-up.…”