One Year Overview and Follow-Up in a Post-COVID Consultation of Critically Ill Patients

Jessica González, María Zuil, Iván D Benítez, David de Gonzalo-Calvo, María Aguilar, Sally Santisteve, Rafaela Vaca, Olga Minguez, Faty Seck, Gerard Torres, Jordi de Batlle, Silvia Gómez, Silvia Barril, Anna Moncusí-Moix, Aida Monge, Clara Gort-Paniello, Ricard Ferrer, Adrián Ceccato, Laia Fernández, Ana Motos, Jordi Riera, Rosario Menéndez, Darío Garcia-Gasulla, Oscar Peñuelas, Gonzalo Labarca, Jesús Caballero, Carme Barberà, Antoni Torres, Ferran Barbé, Jessica González, María Zuil, Iván D Benítez, David de Gonzalo-Calvo, María Aguilar, Sally Santisteve, Rafaela Vaca, Olga Minguez, Faty Seck, Gerard Torres, Jordi de Batlle, Silvia Gómez, Silvia Barril, Anna Moncusí-Moix, Aida Monge, Clara Gort-Paniello, Ricard Ferrer, Adrián Ceccato, Laia Fernández, Ana Motos, Jordi Riera, Rosario Menéndez, Darío Garcia-Gasulla, Oscar Peñuelas, Gonzalo Labarca, Jesús Caballero, Carme Barberà, Antoni Torres, Ferran Barbé

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.

Keywords: COVID-19; CT abnormalities; SARS; SARS-CoV-2; intensive care unit (ICU); lung function; post-COVID syndrome; sequelae.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 González, Zuil, Benítez, de Gonzalo-Calvo, Aguilar, Santisteve, Vaca, Minguez, Seck, Torres, de Batlle, Gómez, Barril, Moncusí-Moix, Monge, Gort-Paniello, Ferrer, Ceccato, Fernández, Motos, Riera, Menéndez, Garcia-Gasulla, Peñuelas, Labarca, Caballero, Barberà, Torres and Barbé.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study.
FIGURE 2
FIGURE 2
Overview of clinical decisions and percentage of recovered patients regarding post-COVID unit (A), DLCO (B), TLC (C), 6MWT (D), and TSS (E) over time. P-values were computed using McNemar’s test. ne, not estimable.

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