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Clinical Outcomes Among Patients With 1-Year Survival Following Intensive Care Unit Treatment for COVID-19

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  What are the 1-year outcomes among patients who survive intensive care unit (ICU) treatment for COVID-19?

Findings  In this exploratory multicenter prospective cohort study that included 246 patients who were alive 1 year following ICU treatment for COVID-19, 74.3% reported physical symptoms, 26.2% reported mental symptoms, and 16.2% reported cognitive symptoms.

Meaning  Physical, mental, and cognitive symptoms were frequent 1 year after ICU treatment for COVID-19.

Abstract

Importance  One-year outcomes in patients who have had COVID-19 and who received treatment in the intensive care unit (ICU) are unknown.

Objective  To assess the occurrence of physical, mental, and cognitive symptoms among patients with COVID-19 at 1 year after ICU treatment.

Design, Setting, and Participants  An exploratory prospective multicenter cohort study conducted in ICUs of 11 Dutch hospitals. Patients (N = 452) with COVID-19, aged 16 years and older, and alive after hospital discharge following admission to 1 of the 11 ICUs during the first COVID-19 surge (March 1, 2020, until July 1, 2020) were eligible for inclusion. Patients were followed up for 1 year, and the date of final follow-up was June 16, 2021.

Exposures  Patients with COVID-19 who received ICU treatment and survived 1 year after ICU admission.

Main Outcomes and Measures  The main outcomes were self-reported occurrence of physical symptoms (frailty [Clinical Frailty Scale score ≥5], fatigue [Checklist Individual Strength—fatigue subscale score ≥27], physical problems), mental symptoms (anxiety [Hospital Anxiety and Depression {HADS} subscale score ≥8], depression [HADS subscale score ≥8], posttraumatic stress disorder [mean Impact of Event Scale score ≥1.75]), and cognitive symptoms (Cognitive Failure Questionnaire—14 score ≥43) 1 year after ICU treatment and measured with validated questionnaires.

Results  Of the 452 eligible patients, 301 (66.8%) patients could be included, and 246 (81.5%) patients (mean [SD] age, 61.2 [9.3] years; 176 men [71.5%]; median ICU stay, 18 days [IQR, 11 to 32]) completed the 1-year follow-up questionnaires. At 1 year after ICU treatment for COVID-19, physical symptoms were reported by 182 of 245 patients (74.3% [95% CI, 68.3% to 79.6%]), mental symptoms were reported by 64 of 244 patients (26.2% [95% CI, 20.8% to 32.2%]), and cognitive symptoms were reported by 39 of 241 patients (16.2% [95% CI, 11.8% to 21.5%]). The most frequently reported new physical problems were weakened condition (95/244 patients [38.9%]), joint stiffness (64/243 patients [26.3%]) joint pain (62/243 patients [25.5%]), muscle weakness (60/242 patients [24.8%]) and myalgia (52/244 patients [21.3%]).

Conclusions and Relevance  In this exploratory study of patients in 11 Dutch hospitals who survived 1 year following ICU treatment for COVID-19, physical, mental, or cognitive symptoms were frequently reported.

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Article Information

Corresponding Authors: Hidde Heesakkers, MD (hidde.heesakkers@radboudumc.nl) and Marieke Zegers, PhD (marieke.zegers@radboudumc.nl), Department of Intensive Care Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands.

Accepted for Publication: January 3, 2022.

Published Online: January 24, 2022. doi:10.1001/jama.2022.0040

Author Contributions: Dr Heesakkers had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Drs van den Boogaard and Zegers contributed equally as last authors.

Concept and design: Heesakkers, van der Hoeven, van den Boogaard, Zegers.

Acquisition, analysis, or interpretation of data: Heesakkers, van der Hoeven, Corsten, Janssen, Ewalds, Simons, Rettig, Westerhof, Jacobs, van Santen, Slooter, van der Woude, van den Boogaard, Zegers.

Drafting of the manuscript: Heesakkers, van den Boogaard, Zegers.

Critical revision of the manuscript for important intellectual content: van der Hoeven, Corsten, Janssen, Ewalds, Simons, Rettig, Westerhof, Jacobs, van Santen, Slooter, van der Woude, van den Boogaard, Zegers.

Statistical analysis: Heesakkers, van den Boogaard, Zegers.

Obtained funding: van den Boogaard, Zegers.

Administrative, technical, or material support: Corsten, Ewalds, Simons, van Santen, van den Boogaard.

Supervision: van der Hoeven, Janssen, Rettig, Westerhof, Jacobs, Slooter, van der Woude, van den Boogaard, Zegers.

Conflict of Interest Disclosures: None reported.

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