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

ABSTRACT

RATIONALE Recent reports suggest patients with severe coronavirus disease 2019 (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, the 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 at Sao Paulo, Brazil. We assessed patients every three months for one 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 years, 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 [99%CI] 1.94-2.99) and then decreased at 12 months (mean difference 0.67, 99%CI 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 one year. Clinical events occurred in all assessments. CONCLUSIONS: Although a higher burden of disabilities and cognitive symptoms occurred three months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the one-year follow-up. However, one third of the patients still remained in worse conditions than their pre-COVID status.