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27th January 2022
Intensive care unit (ICU) patients continue to frequently experience physical, mental and cognitive symptoms one year after their acute infection with COVID-19. This was the main finding from a study by researchers from the Radboud University Medical Center, Nijmegen, the Netherlands.
ICU patients who survive serious illnesses such as acute respiratory distress syndrome are known to have persistent functional disability one year after discharge from an intensive care unit. Moreover, during the current pandemic, patients recovering from severe COVID-19 have been found to present with early mild to moderate functional impairment, mildly reduced quality of life and a worsening of pain and depression/anxiety symptoms at 6 months. In addition, other work indicates frequent cognitive sequelae after infection with COVID-19.
However, longer-term outcome data among ICU patients admitted to these units due to COVID-19, is lacking. As a result, for the present study, the Dutch researchers set out to establish the extent of any long-term physical, mental and cognitive symptoms among this patient cohort. They recruited patients discharged from ICU due to COVID-19 but excluded individuals whose stay in ICU was less than 12 hours as well as those with a life expectancy of less than 48 hours. For the three main outcomes, the team assessed physical symptoms based on the Clinical Fragility Score (CFS) for which the cut-off score, indicative of frailty is 5. Mental symptoms such as anxiety and depression were measured using the Hospital Anxiety and Depression scale (HADS), which has a cut-off value of 8 and finally, cognitive symptoms were assessed using the abbreviated Cognitive Failure Questionnaire-14, for which the cut-off score was 43.
ICU patients mental, physical and cognitive scores
A total of 246 patients with a mean age of 61.2 years (71.5% male) completed the one-year follow-up questionnaires.
At 12 months 74.3% of ICU patients reported physical symptoms compared to 26.2% for mental and 16.2% for cognitive symptoms respectively. In addition, 30.6% of patients reported symptoms from at least two of these domains with 10.5% having symptoms from all three domains. For the CFS, the median value after one year was 2, with 6.1% of patients exceeding the cut-off score for frailty. Similarly, 18.3% exceeded the cut-off score for HADS, indicating anxiety and depression and 16.2% exceeded the cognitive failure score cut-off.
Among the range of new physical symptoms developed, 38.9% reported a weakened condition, 26.3% reported joint stiffness, followed by joint pain (25.5%) and muscle weakness (24.8%). Symptoms of anxiety and depression were reported by 17.9% and 18.3% respectively.
The authors concluded that among ICU patients, one year after treatment, physical, mental and cognitive symptoms continued to be reported.
Heesakkers H et al. Clinical Outcomes Among Patients With 1-Year Survival Following Intensive Care Unit Treatment for COVID-19 JAMA 2020