Recovery from Covid-19 critical illness: A secondary analysis of the ISARIC4C CCP-UK cohort study and the RECOVER trial

  1. Ellen Pauley
  2. Thomas M Drake
  3. David M Griffith
  4. Louise Sigfrid
  5. Nazir I Lone
  6. Ewen M Harrison
  7. J Kenneth Baillie
  8. Janet T Scott
  9. Timothy S Walsh
  10. Malcolm G Semple
  11. Annemarie B Docherty
  12. on behalf of the ISARIC4C and RECOVER Investigators

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Abstract

We aimed to compare the prevalence and severity of fatigue in survivors of Covid-19 versus non-Covid-19 critical illness, and to explore potential associations between baseline characteristics and worse recovery.

Methods:

We conducted a secondary analysis of two prospectively collected datasets. The population included was 92 patients who received invasive mechanical ventilation (IMV) with Covid-19, and 240 patients who received IMV with non-Covid-19 illness before the pandemic. Follow-up data were collected post-hospital discharge using self-reported questionnaires. The main outcome measures were self-reported fatigue severity and the prevalence of severe fatigue (severity >7/10) 3 and 12-months post-hospital discharge.

Results:

Covid-19 IMV-patients were significantly younger with less prior comorbidity, and more males, than pre-pandemic IMV-patients. At 3-months, the prevalence (38.9% [7/18] vs. 27.1% [51/188]) and severity (median 5.5/10 vs 5.0/10) of fatigue were similar between the Covid-19 and pre-pandemic populations, respectively. At 6-months, the prevalence (10.3% [3/29] vs. 32.5% [54/166]) and severity (median 2.0/10 vs. 5.7/10) of fatigue were less in the Covid-19 cohort. In the total sample of IMV-patients included (i.e. all Covid-19 and pre-pandemic patients), having Covid-19 was significantly associated with less severe fatigue (severity <7/10) after adjusting for age, sex and prior comorbidity (adjusted OR 0.35 (95%CI 0.15–0.76, p=0.01).

Conclusion:

Fatigue may be less severe after Covid-19 than after other critical illness.

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  1. Version published to 10.1177/17511437211052226
  2. ScreenIT

    SciScore for 10.1101/2021.06.15.21258879: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationPatients randomised to the intervention group received enhanced hospital and community-based physical rehabilitation, the control group received routine care21.
    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:
    There are several important limitations to our study that must be considered. Firstly, our findings may be subject to responder and survivor bias. The sample sizes included by both CCP-UK and RECOVER were relatively small, and individuals with milder symptoms may have felt less compelled to respond, and those with the most severe symptoms or who died would have been unable to respond. We controlled for CCP-UK and RECOVER measuring outcomes at different timepoints by stratifying fatigue by time since hospital discharge, which allowed equivalent timepoints to be compared but further restricted sample sizes. Secondly, our results may not be fully representative of all survivors of Covid-19 or non-Covid critical illness, as only patients admitted to a few UK hospitals were included (31 hospitals in CCP-UK, 2 in RECOVER). Thirdly, as CCP-UK and RECOVER did not use the same outcome measures, we were unable to explore differences in acute illness severity (including duration of IMV), breathlessness level, and QOL between Covid-19 and pre-pandemic patients. An ideal study design would have used retrospective measurements of pre-critical illness functional levels, utilised repeated measures (much like the RECOVER study) of those with Covid-19, and would also feature a non-Covid-19 contemporaneous control group, to control for other factors which may impact post-ICU recovery, such as the ‘lockdown’ restrictions in place during CCP-UK’s study period or the level of follow-up care availa...

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

    IdentifierStatusTitle
    ISRCTN66726260NANA

    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.

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  3. Version published to 10.1101/2021.06.15.21258879v1 on medRxiv