Disability burden, cognitive impairment improve 1 year after critical COVID-19

Key takeaways:

• Fewer disabilities and cognitive symptoms were found at 1 year vs. 3 months post-hospital discharge.
• Compared with before COVID-19, more survivors were frail and had impaired cognition 12 months post-discharge.

ICU COVID-19 survivors showed improvement in disability, frailty and cognitive impairment 1 year after discharge, according to study results published in Annals of the American Thoracic Society.

However, some survivors did not struggle with these burdens prior to their infection, according to researchers.

“Our results were two-faceted because, although most of our participants improved their health status throughout the 12 months of follow-up, one in three persisted with poorer function, and one in 10 with worse cognition than their baseline,” Leandro U. Taniguchi, MD, PhD, of emergency medicine discipline at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, and colleagues wrote.

In a longitudinal prospective cohort study, Taniguchi and colleagues assessed 428 ICU COVID-19 survivors (mean age, 64 years; 57% men) in São Paulo, to evaluate the prevalence of various clinical outcomes 1 year after experiencing critical COVID-19.

Researchers followed-up with patients for 1 year after their hospitalization, checking in with them at 3, 6, 9 and 12 months to track disabilities, frailty, cognition and clinical events such as rehospitalization, institutionalization and falls.

Of the total cohort, 61% needed invasive mechanical ventilation when they were hospitalized, and 19 patients (4%) died during the study period.

In terms of disabilities, COVID-19 survivors had a greater number of disabilities at 3 months than what was observed before COVID-19 (mean difference, 2.46; 99% CI, 1.94-2.99). However, researchers noted that at 12 months, the disability burden went down, signaling improvement (mean difference, 0.67; 99% CI, 0.28-1.07).

Importantly, out of 393 survivors, 141 (36%) experienced a higher number of disabilities at the end of the study period compared with before they contracted COVID-19, according to researchers.

Similarly, researchers found that more COVID-19 survivors had cognitive symptoms at 3 months than in the 12th month following their discharge (17% vs. 12.1%; P = .012). Interestingly, researchers found no previous records of dementia, memory complaints or any activities of daily living disability in 60% of the patients who demonstrated cognitive impairment at 12 months, demonstrating that more than half of patients who still had cognitive impairment at the end of the study did not struggle with this prior to COVID-19.

Before contracting a critical COVID-19 infection, 14% of patients were frail, and this increased to 32% at 3 months. Three months showed the highest prevalence of frailty with lower rates found at 6 months (20%), 9 months (13%) and 12 months (12%). Despite this improvement, researchers found that 22 patients (47%) identified as frail at 1 year were not characterized in this way prior to their illness.

Lastly, researchers observed several increases and decreases of clinical events over 1 year after discharge. The highest percentage of readmissions occurred at 9 months (5.8%) and the lowest at 12 months (4%). A similar trend was observed in emergency visits with the highest rate at 9 months (11.9%) and the lowest at 12 months (7.5%). For falls, the highest percentage occurred at 6 months (9.6%), but the lowest still occurred at 12 months (5.2%).

Of the total cohort, institutionalization occurred in just four survivors.

“Our results should be helpful to providers who need to plan the allocation of rehabilitation resources after discharge and inform patients, families and caregivers on what to expect after recovering from critical COVID-19,” Taniguchi and colleagues wrote.

This study by Taniguchi and colleagues contributes to growing literature on long-term effects of COVID-19, but other factors of care must be addressed in future studies since this study took place at the very beginning of the COVID-19 pandemic, according to an accompanying editorial by Catherine L. Auriemma, MD, MS, instructor of medicine in the division of pulmonary, allergy and critical care at the University of Pennsylvania’s Perelman School of Medicine, and Lauren E. Ferrante, MD, MHS, assistant professor of medicine in the pulmonary, critical care and sleep medicine section at Yale School of Medicine.

“The patients enrolled in this cohort were all hospitalized from March to July 2020, well before the advent of vaccination and improved treatments for COVID-19,” Auriemma and Ferrante wrote. “It is uncertain how directly we can apply the findings from Taniguchi and colleagues to current clinical practice. Ongoing longitudinal assessments of hospitalized and critically ill patients with COVID-19 among more contemporary cohorts are needed.

“Moreover, detailed patient-level information about treatment characteristics, such as mode of mechanical ventilation, use of paralytics and sedatives, and receipt of physical therapy, and important potential mediators, such as the onset of delirium, would enhance our understanding of how frailty, disability, and cognitive impairment are related to both underlying disease and ICU management,” they added.

Reference:

• Auriemma CL, et al. Ann Am Thorac Soc. 2023;doi:10.1513/AnnalsATS.202211-929ED.