Do Covid-19 patients needing ICU admission have worse 6 months follow up outcomes when compared with hospitalized non-ICU patients? A prospective cohort study

  1. Süleyman Yıldırım
  2. Seher Susam
  3. Pınar Cimen
  4. Sena Yapicioglu
  5. Onur Sunecli
  6. Özlem Ediboglu
  7. Cenk Kirakli

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Abstract

Introduction

Studies focus on pathogenesis, clinical manifestations, and complications during the early phase of the coronavirus disease-19 (COVID-19). Long-term outcomes of COVID-19 patients who discharge intensive care unit (ICU) are unclear.

Objectives

We investigated the effect of COVID-19 on lung structure, pulmonary functional, exercise capacity and quality of life in patients discharge from ICU and medical ward.

Methods

A prospective single-centre study conducted in PCR confirmed COVID-19 patients who has been discharged from University of Health Sciences, Dr. Suat Seren Chest Disease and Thoracic Surgery Teaching and Research Hospital between 15 January and 5 March 2021. Patients who followed up for more than 48 hours in ICU and more than 72 hours in medical ward were included the study. Computed tomography scores, pulmonary functional tests (PFT), 6-min walking distance and health related quality of life by SF-36 were compared between ICU and medical ward patients at 6 months after discharge.

Results

Seventy patients were included final analyses and 31 of them discharged from ICU. ICU patients had higher CT scores than non-ICU patients at admission (17 vs 11) and follow up visit (6 vs 0). Two-three of ICU patients had at least one abnormal finding at control CT. Advanced age (OR 1.08, 95% CI 1.02-1.15) and higher CT score at admission (OR 1.13, 95% CI 1.01-1.27) were risk factors for having radiological abnormalities at control CT.

Conclusion

A number of COVID-19 survivors especially with severe disease could not fully recover after 6 months of hospital discharge.

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  1. ScreenIT

    SciScore for 10.1101/2021.08.17.21262177: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Our study was approved by the ethics committee of University of Health Sciences, Dr. Suat Seren Chest Disease and Thoracic Surgery Teaching and Research Hospital (ethical approval number: 19-28.09.2020).
    Consent: Written informed consent was obtained from all participants.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Impairment of quality of life was observed in SF-36 categories, especially social functioning, role limitation due to physical and emotional problems. Impairment of quality of life was similar in both ICU and non-ICU patients. This result is consistent with long term follow up in SARS patients24. The percentage of residual symptoms and impairment of health status were significantly higher in female participants. Female survivors were more prone to depression and anxiety after the previous SARS outbreak33. Severity of disease and female gender were found to be risk factors for persistent psychological symptoms28. Not just disease-related causes, but also social restrictions (such as quarantine, and curfew to prevent spread of the disease), increased stress, anxiety, and depression in females34. Psychological distress, anxiety and depression may aggravate persistent symptoms and influence the impairment of quality of life. This study has several limitations. This is a single-centre study so these results cannot be generalized to other centres. Although the desired number of patients could not be reached in the ICU patients group, the study has enough power (0.83) to test the difference between the two groups for the primary outcome. We could not measure diffusion of carbon monoxide (DLCO), which is frequently impaired in patients with SARS or COVID-19, due to technical reasons in our pulmonary functional centre. The baseline data of PFT and 6-min walking distance were unknown s...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04715919RecruitingLong Term Outcomes of Coronavirus Disease-19 (COVID-19)

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.08.17.21262177v1 on medRxiv