Critically ill patients with Covid-19 and those without Covid-19 requiring mechanical ventilation have similar incidence and severity of new disability after recovery, according to a new study from Australia published in The American Journal of Respiratory and Critical Care Medicine.¹ Cognitive and psychological function and health related quality of life were also comparable between the two.

In this study, researchers examined critically ill Covid-19 and non-Covid-19 patients with the primary objective to verify if death or new disability at 6 months in mechanically ventilated patients admitted to ICUs were worse in Covid-19 patients versus those without Covid-19. The study sample was sourced from two prospective observational studies involving patients in ICUs. Non-Covid patients were eligible if they had been mechanically ventilated for more than 24 hours because of acute respiratory failure not due to congestive heart failure. Patients with Covid between March 6, 2020, and April 21, 2021 were included from the COVID-Recovery study and those without Covid, between August 2017 and January 2019, were recruited from the PREDICT study. The functional outcomes of survivors were also compared as the secondary end point of the study.

Analysis of data revealed that Covid-19 patients were older than those who did not have Covid-19; 62 years vs 58 years, respectively. They had lower Acute Physiology and Chronic Health Evaluation II scores; 17 vs 19, respectively. This score has been shown to be a better predictor of in-hospital mortality in Covid-19 patients. A score of 17 or higher is regarded as indicator of mortality.²

Covid patients required mechanical ventilation for a longer duration of time (12 days; 5-19 days) than the non-covid patients with acute respiratory failure who received mechanical ventilation for nearly 5 days (2.3-8.8 days). But at 6 months, the mortality was similar between the two groups; 32.5% vs 35.2%.

The primary outcomes were similar with comparable incidence of death or new disability between the two groups at 62.4% vs 66.0%. At 6 months, the incidence of anxiety, depression, cognitive impairment or post-traumatic stress disorder as measured by the Hospital Anxiety and Depression Scale (HADS), Impact of Events-6, Montreal Cognitive Assessment-BLIND and Instrumental Activities of Daily Living scales, respectively, were equivalent between the two groups.

No differences were noted with regard to the EQ-5D-5L utility scale and the EQ-5D visual analogue scale. This scale measures the health-related quality of life using five dimensions of mobility, self-care, usual activities, pain/discomfort and anxiety/depression with levels ranging from no problems to extreme problems.³

Seriously ill ICU patients often continue to struggle with physical, psychological and cognitive issues even after discharge, which has been termed as post-intensive care syndrome. In this study, patients in both groups reported new disabilities such as difficulty in walking or standing, trouble  with concentration, and emotional problems, although the incidence and severity of new-onset disability, health-related quality of life, psychological and cognitive function between Covid-19 patients and those with non-Covid respiratory failure were similar. It highlights the significance of assessment of functional status for all patients who survive their critical illness to detect any disability and referring them timely to hasten recovery post-discharge.

References

1. Hodgson CL, et al. Comparison of 6-month outcomes of survivors of COVID-19 versus non-COVID-19 critical illness. Am J Respir Crit Care Med. 2022 May 15;205(10):1159-1168. doi: 10.1164/rccm.202110-2335OC.
2. Zou X, et al. Acute Physiology and Chronic Health Evaluation II Score as a predictor of hospital mortality in patients of Coronavirus Disease 2019. Crit Care Med. 2020;48(8):e657-e665.
3. https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/.