In a recent article published in the journal Scientific Reports, researchers performed a prospective study at the University Hospital of Wuerzburg in Germany among coronavirus disease 2019 (COVID-19) patients who sought hospital admission to determine how it affected their health-related quality of life (HRQoL) after recovery.
The study covered 85 patients admitted to intensive care units (ICU) and non-ICU units due to COVID-19-related complications between March 2020 and December 2020.
Study: Prospective single-center study of health-related quality of life after COVID-19 in ICU and non-ICU patients. Image Credit: p.ill.i / Shutterstock
Background
COVID-19 manifests as an asymptomatic infection to critical illness but does not end in patient survival. Among a majority of recovered patients, fatigue, cognitive deficits, post-traumatic stress disorder (PTSD), and muscle weakness persist for a prolonged duration, hampering their QoL.
Several recent meta-analyses suggested that HRQoL among female and older patients remained poorer, though it was impaired persistently among all patients studied. QoL is multifaceted with physical and mental health components; however, socio-economic conditions and the environment also impact it.
In earlier studies, they used traditional parameters, such as mortality and other physiologic measures, to draw correlations between an illness and QoL. However, self-perceived physical and mental status has become more recognized as a significant outcome of higher HRQoL.
About the study
In the present study, researchers interviewed all eligible patients three and 12 months after hospital discharge, besides asking them to fill out questionnaires that encompassed questions regarding their physical and mental health, fatigue levels, and QoL.
The questionnaires gathered each participant's score on six scales focused on HRQoL, anxiety, depression, stress, and fatigue, as follows:
i) the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L),
ii) the generalized anxiety disorder-7 (GAD-7),
iii) patient health questionnaire-9 (PHQ-9),
iv) perceived stress scale (PSS-10),
v) post-traumatic symptom scale 10 (PTSS-10), and
vi) FACIT fatigue scale
Furthermore, the researchers assessed clinical frailty during the three- and 12-month follow-ups. They presented continuous and categorical variables as median and percentages, respectively.
Results
The team could evaluate 27 and 30 ICU patients during the three- and 12-month follow-ups, respectively. Likewise, they followed up with 35 and 38 non-ICU patients for three- and 12 months, respectively. At both time points, three and 12 months after hospital discharge, ICU patients showed reduced HRQoL, with substantially minimal improvement in their condition after one year than non-ICU patients. COVID-19 most severely impaired affected patients' mobility and day-to-day life.
The percentage of non-ICU patients with no problems in all five EQ-5D-5L dimensions, a widely applicable instrument of general HRQoL, was lower, indicating that long-term sequelae were common even among non-ICU COVID-19 cases. Strikingly, all EQ-5D-5L dimensions were limited in ICU patients. Less than one-fourth carried out their day-to-day activities, though one-third had no mental or physical issues, such as pain, mobility problems, depression, and anxiety.
Nearly one-fifth of all patients suffered from depression, of which 18% and 20% were non-ICU and ICU patients, respectively. A significant number of patients had severe fatigue and stress; however, a lower fraction of ICU patients had fatigue or an anxiety disorder.
PTSD was less common in non-ICU patients, but 10% of COVID-19 ICU patients had suspected PTSD, while 23% were at risk. Also, a higher percentage of ICU patients had high levels of self-perceived stress than non-ICU patients. Unfortunately, almost all ICU survivors experienced moderate to high-stress levels a year after discharge.
Conclusions
Overall, the study data highlighted the complexity of the long-term sequelae of COVID-19 and the necessity to generate awareness about monitoring the mental well-being of patients and primary care providers.
In this study, ICU survivors had a reduced HRQoL, similar to how a meta-analysis described that acute respiratory distress syndrome (ARDS) could significantly impair long-term QoL. Conversely, other kinds of survivors, such as those of acute kidney injury, had a relatively better QoL than their age- and gender-matched counterparts.
Studies have also evidenced that reduced HRQoL is not an unacceptable outcome. For instance, in a study conducted among 1453 ICU survivors, ~95% self-reported their abridged HRQoL with an EQ-5D-index of 0.81 as acceptable. They considered an EQ-5D-index equal to 0.57 unacceptable, though its cut-off value could not be well-demarcated.
Furthermore, in this study, the authors noted that while mental disorders were common, PTSD or anxiety were less observed. However, most patients lived independently at home after a year of recovering from COVID-19-related hospitalization.
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