Predictors of Long-term Muscle Weakness in Survivors of Covid-19 Acute Respiratory Distress Syndrome (preprint)

Background Long-term weakness is common in survivors of COVID-19–associated acute respiratory distress syndrome (CARDS). We assessed the predictors of muscle weakness in patients evaluated at 3, 6, and 12 months after intensive care unit discharge with in-person visits.Methods Muscle strength was measured by isometric maximal voluntary contraction (MVC) of the tibialis anterior muscle. Candidate predictors of muscle weakness were follow-up time, sex, age, mechanical ventilation duration, use of steroids in the intensive care unit, compound muscle action potential of the tibialis anterior muscle (CMAP-TA-S100), severe fatigue, depression and anxiety, post-traumatic stress disorder, cognitive assessment, and body mass index. We also compared the clinical tools currently available for the evaluation of muscle strength (handgrip strength, Medical Research Council sum score) and electrical neuromuscular function (simplified peroneal nerve test [PENT]) with more objective and robust measures of force (MVC) and electrophysiological evaluation of the neuromuscular function of the tibialis anterior muscle (CMAP-TA-S100) for its essential role in ankle control.Results MVC improved at 12 months compared with 3 months. Sex (P < 0.001), age (P = 0.012), duration of mechanical ventilation (P = 0.044), and CMAP-TA-S100 (P < 0.001) were independent predictors of MVC. MVC was strongly associated with handgrip strength, whereas CMAP-TA-S100 was strongly associated with PENT.Conclusions Female sex, increasing age, increased duration of mechanical ventilation, and electrical neuromuscular abnormalities are independently associated with reduced MVC and can be used to predict the risk of long-term muscle weakness in CARDS survivors.Trial registration : The present study was registered at ClinicalTrial.gov (NCT: ​​NCT04608994). Registered on October 30, 2020. Retrospectively registered.

Long-term physical impairments in survivors of COVID-19-associated ARDS compared to classic ARDS. A Two-Center Study (preprint)

We carried out a prospective and retrospective case series study to compare physical outcome performance with an in-person evaluation of 248 COVID-related ARDS (CARDS) patients and 48 classic ARDS patients. At 6 months, patients with classic ARDS compared to CARDS had lower MRCss, handgrip dynamometry, and 6 Minutes Walk Test. Fatigue was more frequently reported by patients with classic ARDS. At 12 months, patients in both groups partially regained physical performances, and the differences in measured variables between classic ARDS and CARDS remained constant over time. Reasons for these differences are likely multifactorial and require further investigations.

Three-Month Outcome in Survivors of COVID-19 Associated Acute Respiratory Distress Syndrome (preprint)

BACKGROUND: Survivors of acute respiratory distress syndrome (ARDS) frequently experience long-lasting physical, cognitive and mental impairments. We aimed to characterize persisting disabilities in survivors of COVID-19-associated ARDS at three months after hospital discharge.METHODS: Patients were assessed serially with a structured telephone interview, complete clinical chart and X-ray review and in-person visit at a follow-up clinic.FINDINGS: Of the 93 survivors, 3 (3%) were lost to follow-up, 8 (8%) were totally dependent and 82 were independent in activities of daily living (ADL). Of these 82 patients, 25 had reached independence at hospital discharge and refused further evaluation, whereas 57 consented to participate in the follow-up visit. Two patients (3·5%) had significant muscle weakness, and 20 (35%) had critical illness neuropathy or myopathy. Median distance walked in 6 minutes, and median scores of SF-36 Physical functioning and Role limitations due to physical problems were normal. Severe fatigue was reported by 36% of patients. Thirty-six patients (63%) returned to previous work. Cognitive and mental function were normal or only mildly impaired in 96% of patients. Median SF-36 physical and mental component scores were 86% and 100% of predicted values. Interstitial and alveolar chest-X ray abnormalities were found in 30 of 43 patients. Spirometry showed restrictive or obstructive patterns in 9 of 17 patients and altered DLCO in 10.INTERPRETATION: Survivors of COVID-19-associated ARDS have fast recovery of physical functioning at the body level, of the whole person and as participation in a social context. Cognitive and mental function, quality of life and independence in ADL are also rapidly re-established.TRIAL REGISTRATION: NCT04608994FUNDING: The study was funded by FONDAZIONE ALESSANDRA BONO ONLUS, a non-profit organization - Via Fornaci 33, 25040 Corte Franca (BS), Italy https://www.fondazionealessandrabono.itDECLARATION OF INTERESTS: All authors declare no conflicts of interest.ETHICS APPROVAL STATEMENT: The Brescia Ethics committee approved the study (NP 2595).

Six-Month Outcome in Survivors of COVID-19 Associated Acute Respiratory Distress Syndrome (preprint)

BACKGROUND: Survivors of acute respiratory distress syndrome (ARDS) frequently experience long-lasting physical, cognitive and mental impairments. We aimed to characterize persisting disabilities in survivors of COVID-19-associated ARDS at three and six months after hospital discharge.METHODS: Patients were assessed serially with a structured telephone interview, complete clinical chart and X-ray review and in-person visit at a follow-up clinic.FINDINGS: Of the 93 survivors, 3 (3%) were lost to follow-up, 8 (8%) were totally dependent and 82 were independent in activities of daily living (ADL). Of these 82 patients, 25 had reached independence at hospital discharge and refused further evaluation, whereas 57 consented to participate in the follow-up visit at 3 months and 45 at 6 months. Muscle strength, performance-based and self reported measures of physical activity and measures of participation in ADL were normal at 6 months, but severe fatigue was common (36%) and remained unchanged over time. Cognitive and mental function were normal or only mildly impaired in most patients. At 6 months, the median physical and mental component summaries of the SF-36 were 100% of predicted values, and all patients were independent in ADL. Chest X-ray and pulmonary function were altered in a considerable proportion of patients at 3 months, but very few patients had persisting respiratory symptoms at 6 months.INTERPRETATION: Survivors of COVID-19-associated ARDS have fast recovery of physical functioning at the body level, of the whole person and as participation in a social context. Cognitive and mental function, quality of life and independence in ADL are also rapidly re-established.TRIAL REGISTRATION: NCT04608994FUNDING STATEMENT: The study was funded by FONDAZIONE ALESSANDRA BONO ONLUS, a non-profit organization - Via Fornaci 33, 25040 Corte Franca (BS), Italy https://www.fondazionealessandrabono.itDECLARATION OF INTERESTS: All authors declare no conflicts of interest.ETHICS APPROVAL STATEMENT: The Brescia Ethics committee approved the study (NP 2595).