One Year Overview and Follow-Up in a Post-COVID Consultation of Critically Ill Patients
Jessica González1,2,3,4, María Zuil1,2,3,4, Iván D Benítez2,3,4
1Department of Pulmonary, Hospital Universitari Arnau de Vilanova and Santa Maria, Lleida, Spain.
Insights
Critical COVID-19 survivors often experience long-term respiratory issues and post-COVID syndrome. One-third require extended follow-up care beyond one year due to persistent symptoms and lung abnormalities.
Area of Science:
- Pulmonology
- Critical Care Medicine
- Infectious Diseases
Background:
- Long-term outcomes for critical COVID-19 survivors remain incompletely understood.
- Detailed clinical management and evolution data are scarce for this patient group.
Purpose of the Study:
- To prospectively evaluate the long-term clinical management and evolution of critical COVID-19 survivors.
- To assess the prevalence of post-COVID-19 syndrome and identify persistent health issues at one year.
Main Methods:
- Prospective observational study of 105 intensive care unit (ICU) COVID-19 survivors.
- Follow-up included symptom assessment, pulmonary function tests, 6-minute walking test (6MWT), chest computed tomography (CT), and questionnaires at one year.
Main Results:
- 32.2% required continued follow-up due to respiratory alterations.
- 10% had moderate/severe lung diffusion (DLCO) impairment, and 53.7% showed fibrotic patterns on CT.
- 61.3% met criteria for post-COVID syndrome, with a mean of 5.7 symptoms; other conditions like COPD and neurocognitive disorders were also identified.
Conclusions:
- A significant proportion of critical COVID-19 survivors necessitate follow-up beyond one year.
- Persistent respiratory abnormalities (DLCO, CT findings) and post-COVID syndrome are common.
- Critical illness from COVID-19 leads to substantial long-term health burdens and high healthcare resource utilization.
Abstract:
The long-term clinical management and evolution of a cohort of critical COVID-19 survivors have not been described in detail. We report a prospective observational study of COVID-19 patients admitted to the ICU between March and August 2020. The follow-up in a post-COVID consultation comprised symptoms, pulmonary function tests, the 6-minute walking test (6MWT), and chest computed tomography (CT). Additionally, questionnaires to evaluate the prevalence of post-COVID-19 syndrome were administered at 1 year. A total of 181 patients were admitted to the ICU during the study period. They were middle-aged (median [IQR] of 61 [52;67]) and male (66.9%), with a median ICU stay of 9 (5-24.2) days. 20% died in the hospital, and 39 were not able to be included. A cohort of 105 patients initiated the follow-up. At 1 year, 32.2% persisted with respiratory alterations and needed to continue the follow-up. Ten percent still had moderate/severe lung diffusion (DLCO) involvement (<60%), and 53.7% had a fibrotic pattern on CT. Moreover, patients had a mean (SD) number of symptoms of 5.7 ± 4.6, and 61.3% met the criteria for post-COVID syndrome at 1 year. During the follow-up, 46 patients were discharged, and 16 were transferred to other consultations. Other conditions, such as emphysema (21.6%), COPD (8.2%), severe neurocognitive disorders (4.1%), and lung cancer (1%) were identified. A high use of health care resources is observed in the first year. In conclusion, one-third of critically ill COVID-19 patients need to continue follow-up beyond 1 year, due to abnormalities on DLCO, chest CT, or persistent symptoms.
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