COVID-19 ARDS Patients Face High Four-Year Mortality and Persistent Health Issues

Four-Year Mortality and Quality of Life for COVID-19 ARDS Survivors: A Polish Study Reveals Lingering Impacts

A recent study published in "Scientific Reports" has shed light on the long-term health outcomes of patients treated in intensive care units (ICU) for COVID-19-associated acute respiratory distress syndrome (ARDS), investigating their four-year mortality rate and health-related quality of life (HRQoL).

Background

COVID-19 survivors, particularly those who experienced critical acute illness, frequently grapple with long-term health issues. At the pandemic's peak, a significant proportion – up to 15% – of patients required advanced respiratory support, including invasive or non-invasive ventilation. Despite substantial advancements in acute care, ICU mortality rates for these patients have remained high.

Previous research has highlighted persistent fatigue, dyspnea (shortness of breath), and cognitive complaints among survivors. However, the precise long-term trajectory of these impairments has largely remained unclear. Data from Central and Eastern Europe specifically regarding these outcomes have been limited, making this new study particularly valuable.

Study Design and Methods

Researchers conducted a single-center, retrospective-prospective (ambispective) cohort study in Poland. The study involved adult patients admitted to a temporary hospital between December 2020 and July 2021 who had confirmed SARS-CoV-2 infection and ARDS necessitating invasive mechanical ventilation.

Baseline clinical variables, including demographics, comorbidities, vital signs, respiratory parameters, and laboratory markers, were meticulously collected. The length of ICU stay, interval from symptom onset to intubation, and APACHE II score were also recorded. Primary endpoints were assessed at 30 days and four years post-ICU admission. The four-year follow-up involved telephone interviews and vital status verification through electronic or administrative records.

• All-cause mortality at 30 days and four years post-ICU admission.

• Financial burden, sleep disturbance, cognitive complaints, time to return to work, and indirect costs.

• Post-COVID-19 functional status (PCFS) scale for overall functional status.
• Modified Medical Research Council (mMRC) for dyspnea assessment.
• Fatigue assessment scales to quantify fatigue levels.
• Cognitive failures questionnaire for memory and attention difficulties.
• EuroQol-5 Dimension instrument (EQ-5D-5L) and EuroQol visual analogue scale (EQ-VAS) for comprehensive HRQoL evaluation.
• A screening question specifically for insomnia.
• Additional interview items covered rehospitalization, rehabilitation, employment status, subjective financial burden, and return to work.

Multivariable logistic regression models were employed to identify factors associated with both early and late mortality.

Mortality Outcomes

The study cohort comprised 283 COVID-19 ARDS patients who received ICU treatment.

• A significant 29% of patients died within the first 30 days.
• Among those who survived beyond 30 days, an additional 44 patients died during the subsequent follow-up period.

The cumulative mortality over four years after ICU admission was 44.5%.

• Older age and higher white blood cell (WBC) count were independently associated with 30-day mortality in adjusted analyses.
• Initial analysis also revealed higher lactate dehydrogenase (LDH), higher D-dimer levels, lower platelet counts, longer ICU stay, and higher APACHE II scores among non-survivors.

• Older age remained independently associated with late mortality in multivariable analyses.
• Late non-survivors exhibited a more severe acute-phase profile, along with a higher prevalence of pre-existing conditions such as coronary heart disease, chronic obstructive pulmonary disease (COPD), and chronic kidney disease.

Long-Term Functional and Quality of Life Outcomes

Out of the 157 four-year survivors, 81 successfully completed follow-up interviews, providing crucial insights into their ongoing health. The findings among this group highlighted a range of persistent challenges:

• 30% reported functional limitation.
• 47% reported experiencing insomnia.
• 27.5% experienced clinically relevant fatigue.
• 21.3% reported moderate or worse discomfort/pain.
• 15% had not returned to full-time work.
• 39% received rehabilitation at some point during the four years.
• 30% were re-hospitalized at least once.

The median quality-adjusted life years (QALYs) for this survivor group were estimated at 3.7 years. A reduction in QALYs at four years was observed in participants reporting cognitive complaints, those who received rehabilitation, individuals with clinically relevant fatigue or dyspnea, and those who had not returned to full-time work. These reductions may reflect greater baseline impairment among these subgroups.

Conclusions

This single-center cohort study in Poland provides critical insights, indicating a substantially high four-year mortality rate of approximately 45% among COVID-19 ARDS patients who received ICU treatment. Older age was consistently identified as a significant factor associated with both early and late mortality, with a higher WBC count also linked to early mortality.

Among patients fortunate enough to survive for four years, a significant proportion continue to experience lingering symptoms and functional limitations, including persistent dyspnea, sleep disturbance, reduced overall functioning, and cognitive complaints. These findings underscore the profound and lasting impact of severe COVID-19 on patients' health and quality of life.