Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study - 08/12/21

Doi : 10.1016/j.rmed.2021.106665

Lorenzo Gamberini ^a, Carlo Alberto Mazzoli ^a, Irene Prediletto ^b,^c,^⁎ , Harri Sintonen ^d, Gaetano Scaramuzzo ^e, Davide Allegri ^f, Davide Colombo ^g,^h, Tommaso Tonetti ⁱ, Gianluca Zani ^j, Chiara Capozzi ^k, Giorgia Dalpiaz ^l, Vanni Agnoletti ^m, Iacopo Cappellini ⁿ, Gabriele Melegari ^o, Federica Damiani ^p, Maurizio Fusari ^j, Giovanni Gordini ^a, Cristiana Laici ^q, Maria Concetta Lanza ^r, Mirco Leo ^s, Andrea Marudi ^o, Raffaella Papa ^t, Antonella Potalivo ^u, Jonathan Montomoli ^u, Stefania Taddei ^v, Massimiliano Mazzolini ^w, Anna Filomena Ferravante ^x, Roberta Nicali ^y, Vito Marco Ranieri ⁱ, Emanuele Russo ^m, Carlo Alberto Volta ^e, Savino Spadaro ^e
the ICU-RER COVID-19 Collaboration
Marco Tartaglione ^z, Valentina Chiarini ^z, Virginia Buldini ^z, Carlo Coniglio ^z, Federico Moro ^z, Silvia Orlando ^z, Daniele Fecarotti ^z, Nicola Cilloni ^aa, Lorenzo Giuntoli ^aa, Angela Bellocchio ^aa, Emanuele Matteo ^aa, Giacinto Pizzilli ^ab, Antonio Siniscalchi ^ab, Chiara Tartivita ^ab, Irene Cavalli ^ab, Andrea Castelli ^ab, Annalisa Marchio ^ac, Igor Bacchilega ^ac, Laura Bernabé ^ad, Francesca Facondini ^ad, Luca Morini ^ad, Luca Bissoni ^ae, Lorenzo Viola ^ae, Tommaso Meconi ^af, Vittorio Pavoni ^af, Angelica Venni ^af, Aline Pagni ^ag, Patrizia Pompa Cleta ^ag, Marco Cavagnino ^ag, Alessia Guzzo ^ag, Anna Malfatto ^ah, Angelina Adduci ^ah, Silvia Pareschi ^ah, Elisabetta Bertellini ^ai, Jessica Maccieri ^ai, Elisa Marinangeli ^ai, Fabrizio Racca ^aj, Marco Verri ^ak, Giulia Falò ^ak, Elisabetta Marangoni ^ak, Irene Ottaviani ^ak, Francesco Boni ^al, Giulia Felloni ^am, Federico Domenico Baccarini ^am, Marina Terzitta ^an, Stefano Maitan ^an, Lorenzo Tutino ^ao, Angelo Senzi ^ao, Guglielmo Consales ^ao, Filippo Becherucci ^ao
^z Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
^aa Bellaria Hospital, Bologna, Italy
^ab Sant’Orsola-Malpighi University Hospital, Bologna, Italy
^ac Imola Hospital, Bologna, Italy
^ad Infermi Hospital, Rimini, Italy
^ae M.Bufalini Hospital, Cesena, Italy
^af Santa Maria Annunziata Hospital, Firenze, Italy
^ag SS. Trinità Hospital, ASL Novara, Italy
^ah Bentivoglio Hospital, Bentivoglio, Italy
^ai University Hospital of Modena, Modena, Italy
^aj Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
^ak University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy
^al Villa Erbosa Hospital, San Donato Group, Bologna, Italy
^am Santa Maria Delle Croci Hospital, Ravenna, Italy
^an Morgagni-Pierantoni Hospital, Forlì, Italy
^ao Azienda USL Toscana Centro, Prato, Italy

Radiology Collaborators (to be indexed and searchable into PubMed)
Michele Imbriani ^z, Paolo Orlandi ^z, Silvia Candini ^z, Rita Golfieri ^ab, Federica Ciccarese ^ab, Antonio Poerio ^ac, Francesco Muratore ^ad, Fabio Ferrari ^ad, Martina Mughetti ^ae, Emanuela Giampalma ^ae, Loredana Franchini ^ag, Ersenad Neziri ^ag, Marco Miceli ^ah, Maria Teresa Minguzzi ^am, Lorenzo Mellini ^am, Sara Piciucchi ^an
^z Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
^ab Sant’Orsola-Malpighi University Hospital, Bologna, Italy
^ac Imola Hospital, Bologna, Italy
^ad Infermi Hospital, Rimini, Italy
^ae M.Bufalini Hospital, Cesena, Italy
^ag SS. Trinità Hospital, ASL Novara, Italy
^ah Bentivoglio Hospital, Bentivoglio, Italy
^am Santa Maria Delle Croci Hospital, Ravenna, Italy
^an Morgagni-Pierantoni Hospital, Forlì, Italy

Pneumology Collaborators (to be indexed and searchable into PubMed)
Matteo Monari ^aa, Michele Valli ^aa, Federico Daniele ^ap, Martina Ferioli ^ap, Stefano Nava ^ap, Luigi Arcangelo Lazzari Agli ^ad, Ilaria Valentini ^ad, Eva Bernardi ^ad, Bruno Balbi ^aq, Marco Contoli ^ak, Marianna Padovani ^am, Stefano Oldani ^an, Claudia Ravaglia ^an, Patrizio Goti ^ao
^aa Bellaria Hospital, Bologna, Italy
^ad Infermi Hospital, Rimini, Italy
^ak University of Ferrara, Azienda Ospedaliero-Universitaria S. Anna, Cona, Ferrara, Italy
^am Santa Maria Delle Croci Hospital, Ravenna, Italy
^an Morgagni-Pierantoni Hospital, Forlì, Italy
^ao Azienda USL Toscana Centro, Prato, Italy
^ap Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES) – IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant’Orsola-Malpighi – Respiratory and Critical Care Unit, Bologna, Italy
^aq Istituti Clinici Scientifici Maugeri IRCCS, Novara, Italy

^a Department of Anaesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy
^b Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Bologna, Italy
^c IRCCS Azienda Ospedaliero Universitaria di Bologna, University Hospital Sant’Orsola-Malpighi – Respiratory and Critical Care Unit, Bologna, Italy
^d Department of Public Health, University of Helsinki, Helsinki, Finland
^e Department of Translational Medicine and for Romagna, University of Ferrara, Ferrara, Italy
^f Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Italy
^g Anaesthesia and Intensive Care Department – SS. Trinità Hospital, ASL Novara, Italy
^h Health Science Department - Eastern Piedmont University, Italy
ⁱ Alma Mater Studiorum, Dipartimento di Scienze Mediche e Chirurgiche, Anesthesia and Intensive Care Medicine, Policlinico di Sant'Orsola, Università di Bologna, Bologna, Italy
^j Department of Anesthesia and Intensive Care, Santa Maria Delle Croci Hospital, Ravenna, Italy
^k IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
^l Department of Radiology, Bellaria Hospital, Bologna, Italy
^m Anaesthesia and Intensive Care Unit - M.Bufalini Hospital, Cesena, Italy
ⁿ Department of Critical Care Section of Anesthesiology and Intensive Care, Azienda USL Toscana Centro, Prato, Italy
^o Department of Anaesthesiology, University Hospital of Modena, Via Del Pozzo 71, 41100, Modena, Italy
^p Department of Anaesthesia, Intensive Care and Pain Therapy – Imola Hospital, Imola, Italy
^q Postoperative Intensive Care Unit. Medical and Surgical Department of Digestive, Liver and Endocrine-Metabolic Diseases. IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
^r Department of Anesthesia and Intensive Care, G.B. Morgagni-Pierantoni Hospital, Forlì, Italy
^s Department of Anaesthesia and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
^t Anaesthesia and Intensive Care Unit, Santa Maria Annunziata Hospital, Firenze, Italy
^u Department of Anaesthesia and Intensive Care – Infermi Hospital, Rimini, Italy
^v Anaesthesia and Intensive Care Unit, Bentivoglio Hospital, Bentivoglio, Italy
^w Department of Respiratory Medicine, Bellaria Hospital, Bologna, Italy
^x Department of Respiratory Medicine– Infermi Hospital, Rimini, Italy
^y Outpatient Pneumology Department. - SS. Trinità Hospital Borgomanero, ASL NO, Novara, Italy

^∗Corresponding author. Alma Mater Studiorum University of Bologna, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Via Massarenti 9, 40138, Bologna, Italy.Alma Mater Studiorum University of BolognaDepartment of ExperimentalDiagnostic and Specialty Medicine (DIMES)Via Massarenti 9Bologna40138Italy

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Abstract

Background

Health-related quality of life (HRQoL) impairment is often reported among COVID-19 ICU survivors, and little is known about their long-term outcomes.

We evaluated the HRQoL trajectories between 3 months and 1 year after ICU discharge, the factors influencing these trajectories and the presence of clusters of HRQoL profiles in a population of COVID-19 patients who underwent invasive mechanical ventilation (IMV). Moreover, pathophysiological correlations of residual dyspnea were tested.

Methods

We followed up 178 survivors from 16 Italian ICUs up to one year after ICU discharge. HRQoL was investigated through the 15D instrument. Available pulmonary function tests (PFTs) and chest CT scans at 1 year were also collected. A linear mixed-effects model was adopted to identify factors associated with different HRQoL trajectories and a two-step cluster analysis was performed to identify HRQoL clusters.

Results

We found that HRQoL increased during the study period, especially for the significant increase of the physical dimensions, while the mental dimensions and dyspnea remained substantially unchanged. Four main 15D profiles were identified: full recovery (47.2%), bad recovery (5.1%) and two partial recovery clusters with mostly physical (9.6%) or mental (38.2%) dimensions affected. Gender, duration of IMV and number of comorbidities significantly influenced HRQoL trajectories. Persistent dyspnea was reported in 58.4% of patients, and weakly, but significantly, correlated with both DLCO and length of IMV.

Conclusions

HRQoL impairment is frequent 1 year after ICU discharge, and the lowest recovery is found in the mental dimensions. Persistent dyspnea is often reported and weakly correlated with PFTs alterations.

Trial registration

NCT04411459.

Le texte complet de cet article est disponible en PDF.

Highlights

•	Little is know about HRQoL long term evolution in COVID-19.
•	In COVID-19 patients requiring ICU, HRQoL is impaired 1 year after acute phase.
•	The lowest recovery 1 year after COVID-19 emerged in mental dimensions.
•	Persistent dyspnea is reported in more 50% of patients 1 year after COVID-19.
•	Impairment in pulmonary function weakly explains the entity of dyspnea complained.

Le texte complet de cet article est disponible en PDF.

Keywords : COVID-19, Acute respiratory distress syndrome, Health-related quality of life, Dyspnea, Respiratory function tests

Plan

Persistent dyspnea and pulmonary function tests

Limitations

Conclusions

Ethics approval and consent to participate

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Availability of data and materials

Funding

CRediT authorship contribution statement

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Article 106665- novembre 2021 Retour au numéro

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Health-related quality of life profiles, trajectories, persistent symptoms and pulmonary function one year after ICU discharge in invasively ventilated COVID-19 patients, a prospective follow-up study - 08/12/21

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Background

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