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Physical, cognitive and mental health outcomes in 1-year survivors of COVID-19-associated ARDS
  1. Nicola Latronico1,2,3,
  2. Elena Peli2,
  3. Stefano Calza4,
  4. Federica Rodella2,
  5. Maria Paola Novelli2,
  6. Andrea Cella2,
  7. John Marshall5,6,
  8. Dale M Needham7,8,
  9. Frank Antony Rasulo1,2,3,
  10. Simone Piva1,2
  11. LOTO Investigators
    1. 1 Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
    2. 2 Department of Anesthesia, Critical Care and Emergency, ASST Spedali Civili di Brescia, Brescia, Italy
    3. 3 'Alessandra Bono' University Research Center on long-term outcome in patients who survive critical illness, University of Brescia, Brescia, Italy
    4. 4 Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
    5. 5 Department of Surgery, University of Toronto, Toronto, Ontario, Canada
    6. 6 Department of Critical Care, University of Toronto, Toronto, Ontario, Canada
    7. 7 Outcomes After Critical Illness and Surgery (OACIS) Group, Johns Hopkins University, Baltimore, Maryland, USA
    8. 8 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
    1. Correspondence to Professor Nicola Latronico, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Lombardia, Italy; nicola.latronico{at}unibs.it

    Abstract

    We report on the outcome of 114 COVID-19-associated acute respiratory distress syndrome (ARDS) survivors evaluated at 3, 6 and 12 months after intensive care unit discharge with assessment of physical, mental and cognitive impairments. Critical illness polyneuromyopathy was diagnosed in 23 patients (39%). Handgrip dynamometry was 70% predicted at 3 months and significantly improved over time, whereas the 6 min walk test (80% predicted) and severe fatigue (27% of patients) did not. Independence in activities of daily living (ADL) was achieved by 98% at 3 months. Cognitive impairment (28% at 3 months) improved over time, whereas depression, anxiety and post-traumatic stress disorder symptoms, present in 9%, 10% and 4% at 3 months, did not. Normalised health-related quality of life was good. COVID-19-associated ARDS leads to persisting impairment in performance-based measures of physical function, while ADL, cognitive and mental health status, and health-related quality of life may be less impaired. Trial registration number NCT04608994.

    • ARDS
    • COVID-19

    This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

    https://bmj.com/coronavirus/usage

    https://doi.org/10.1136/thoraxjnl-2021-218064

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      Footnotes

      • Twitter @Ards, @DrDaleNeedham

      • NL and EP contributed equally.

      • FAR and SP contributed equally.

      • Collaborators LOng Term Outcome (LOTO) investigators: LOng Term Outcome (LOTO) investigators: Andrea Borghesi, MD, (Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; University Division of Diagnostic Radiology, Spedali Civili University Hospital, Brescia, Italy); Silvia Barbieri, MD; Silvia Capuccini, MD, (Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy); Sergio Cattaneo, MD, (Division of Cardio-Thoracic Intensive Care, Spedali Civili University Hospital, Brescia, Italy); Alberto Giannini, MD, (Unit of Pediatric Anesthesia and Intensive Care, Children's Hospital, Spedali Civili University Hospital, Brescia, Italy); Bruno Guarneri, MD (Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy); Roberto Maroldi, MD (Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy; University Division of Diagnostic Radiology, Spedali Civili University Hospital, Brescia, Italy); Consuelo Meldini, MD, (Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy); Irene Palazzi, Clinical Nutritionist, (Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy); Laura Pini, MD; Claudio Tantucci, MD; (Respiratory Medicine Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy); Gabriele Tomasoni, MD; Francesca Zubani, MD (Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy).

      • Contributors NL, EP, FAR and SP contributed to the study conception and design. NL was responsible for study supervision. Clinical chart review, chest X-ray analysis, pulmonary function test, material preparation and data collection were performed by all collaborators of the LOng Term Outcome (LOTO) Research Center. SC and SP did the statistical analyses. DMN and JM critically revised the manuscript and contributed important intellectual content. The first draft of the manuscript was written by NL and SP. All authors participated in data interpretation and discussion, and read and approved the final manuscript. NL and SP had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

      • Funding The study was funded by Fondazione Alessandra Bono Onlus, a non-profit organisation in Italy (https://www.fondazionealessandrabono.it).

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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