Functional and Quality of Life Outcomes of Critically Ill COVID-19 Survivors at Hospital Discharge and Six Months

Abstract

RATIONALE: Survivors of critical illness are at risk for long-term physical disability and poor quality of life. Changes in health care delivery, such as visitor restrictions and limited availability of therapy services coupled with economic hardship due to the COVID-19 pandemic may exacerbate these long-term consequences. Methods: Patients with respiratory failure requiring advanced respiratory support (endotracheal tube, noninvasive ventilation, or high-flow nasal cannula) and/or shock admitted to the intensive care unit (ICU) with COVID-19 were eligible for enrollment in this prospective observational study. We assessed quality of life (using short form-36 [SF-36]), work status, and independence in activities of daily living (ADLs) in survivors at hospital discharge and 6 months. Quality of life scores were compared to US population norms. An SF-36 score ≥50 is the population norm for both physical and mental scores;scores <45 define significant physical or mental health impairment. Patients underwent assessment for ICU-acquired weakness (ICU-AW) and functional impairment (using Functional Status Score for the ICU (FSS-ICU)) by physical and occupational therapists upon hospital discharge. An FSS-ICU score ≥28 is associated with discharge to home. Analysis of changes over time for the quality of life assessment were performed using paired t-test and tests of proportions. Results: 100 patients were enrolled from April to November 2020. On hospital discharge, 39% of patients had ICU-AW. The median FSS-ICU score on discharge was 24 [20-29], consistent with functional impairment. Fifty-six patients completed the 6-month evaluation with 74.7% follow-up (56/75 alive patients). Mental health impairment was reported by 33% of patients on hospital discharge and declined to 13% at 6 months (p=0.007). Physical health impairment was reported by 70% at discharge and persisted in 46% of patients at 6 months (p=0.007). Patients were independent in ADLs at both hospital admission and 6 months post discharge (90 vs 91%). Only 56% of patients who had been working prior to hospitalization had returned to work at 6 months. Conclusions: Impairments in quality of life and neuromuscular weakness were present at hospital discharge in a significant number of ICU survivors of COVID-19. Similar to the trajectory described in survivors of acute respiratory distress syndrome, despite relatively normal mental health quality of life, persistent physical health impairment was noted in almost half of the survivors at 6 months. Further investigation of the long-term effects of COVID-19 related critical illness and its distinction from post-ICU syndromes from non-COVID-19 critical illness is warranted.