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

Lorenzo Gamberini, Carlo Alberto Mazzoli, Irene Prediletto, Harri Sintonen, Gaetano Scaramuzzo, Davide Allegri, Davide Colombo, Tommaso Tonetti, Gianluca Zani, Chiara Capozzi, Giorgia Dalpiaz, Vanni Agnoletti, Iacopo Cappellini, Gabriele Melegari, Federica Damiani, Maurizio Fusari, Giovanni Gordini, Cristiana Laici, Maria Concetta Lanza, Mirco Leo, Andrea Marudi, Raffaella Papa, Antonella Potalivo, Jonathan Montomoli, Stefania Taddei, Massimiliano Mazzolini, Anna Filomena Ferravante, Roberta Nicali, Vito Marco Ranieri, Emanuele Russo, Carlo Alberto Volta, Savino Spadaro, ICU-RER COVID-19 Collaboration, Radiology Collaborators (to be indexed and searchable into PubMed), Pneumology Collaborators (to be indexed and searchable into PubMed), Marco Tartaglione, Valentina Chiarini, Virginia Buldini, Carlo Coniglio, Federico Moro, Silvia Orlando, Daniele Fecarotti, Nicola Cilloni, Lorenzo Giuntoli, Angela Bellocchio, Emanuele Matteo, Giacinto Pizzilli, Antonio Siniscalchi, Chiara Tartivita, Irene Cavalli, Andrea Castelli, Annalisa Marchio, Igor Bacchilega, Laura Bernabé, Francesca Facondini, Luca Morini, Luca Bissoni, Lorenzo Viola, Tommaso Meconi, Vittorio Pavoni, Angelica Venni, Aline Pagni, Patrizia Pompa Cleta, Marco Cavagnino, Alessia Guzzo, Anna Malfatto, Angelina Adduci, Silvia Pareschi, Elisabetta Bertellini, Jessica Maccieri, Elisa Marinangeli, Fabrizio Racca, Marco Verri, Giulia Falò, Elisabetta Marangoni, Irene Ottaviani, Francesco Boni, Giulia Felloni, Federico Domenico Baccarini, Marina Terzitta, Stefano Maitan, Lorenzo Tutino, Angelo Senzi, Guglielmo Consales, Filippo Becherucci, Michele Imbriani, Paolo Orlandi, Silvia Candini, Rita Golfieri, Federica Ciccarese, Antonio Poerio, Francesco Muratore, Fabio Ferrari, Martina Mughetti, Emanuela Giampalma, Loredana Franchini, Ersenad Neziri, Marco Miceli, Maria Teresa Minguzzi, Lorenzo Mellini, Sara Piciucchi, Matteo Monari, Michele Valli, Federico Daniele, Martina Ferioli, Stefano Nava, Luigi Arcangelo Lazzari Agli, Ilaria Valentini, Eva Bernardi, Bruno Balbi, Marco Contoli, Marianna Padovani, Stefano Oldani, Claudia Ravaglia, Patrizio Goti, Lorenzo Gamberini, Carlo Alberto Mazzoli, Irene Prediletto, Harri Sintonen, Gaetano Scaramuzzo, Davide Allegri, Davide Colombo, Tommaso Tonetti, Gianluca Zani, Chiara Capozzi, Giorgia Dalpiaz, Vanni Agnoletti, Iacopo Cappellini, Gabriele Melegari, Federica Damiani, Maurizio Fusari, Giovanni Gordini, Cristiana Laici, Maria Concetta Lanza, Mirco Leo, Andrea Marudi, Raffaella Papa, Antonella Potalivo, Jonathan Montomoli, Stefania Taddei, Massimiliano Mazzolini, Anna Filomena Ferravante, Roberta Nicali, Vito Marco Ranieri, Emanuele Russo, Carlo Alberto Volta, Savino Spadaro, ICU-RER COVID-19 Collaboration, Radiology Collaborators (to be indexed and searchable into PubMed), Pneumology Collaborators (to be indexed and searchable into PubMed), Marco Tartaglione, Valentina Chiarini, Virginia Buldini, Carlo Coniglio, Federico Moro, Silvia Orlando, Daniele Fecarotti, Nicola Cilloni, Lorenzo Giuntoli, Angela Bellocchio, Emanuele Matteo, Giacinto Pizzilli, Antonio Siniscalchi, Chiara Tartivita, Irene Cavalli, Andrea Castelli, Annalisa Marchio, Igor Bacchilega, Laura Bernabé, Francesca Facondini, Luca Morini, Luca Bissoni, Lorenzo Viola, Tommaso Meconi, Vittorio Pavoni, Angelica Venni, Aline Pagni, Patrizia Pompa Cleta, Marco Cavagnino, Alessia Guzzo, Anna Malfatto, Angelina Adduci, Silvia Pareschi, Elisabetta Bertellini, Jessica Maccieri, Elisa Marinangeli, Fabrizio Racca, Marco Verri, Giulia Falò, Elisabetta Marangoni, Irene Ottaviani, Francesco Boni, Giulia Felloni, Federico Domenico Baccarini, Marina Terzitta, Stefano Maitan, Lorenzo Tutino, Angelo Senzi, Guglielmo Consales, Filippo Becherucci, Michele Imbriani, Paolo Orlandi, Silvia Candini, Rita Golfieri, Federica Ciccarese, Antonio Poerio, Francesco Muratore, Fabio Ferrari, Martina Mughetti, Emanuela Giampalma, Loredana Franchini, Ersenad Neziri, Marco Miceli, Maria Teresa Minguzzi, Lorenzo Mellini, Sara Piciucchi, Matteo Monari, Michele Valli, Federico Daniele, Martina Ferioli, Stefano Nava, Luigi Arcangelo Lazzari Agli, Ilaria Valentini, Eva Bernardi, Bruno Balbi, Marco Contoli, Marianna Padovani, Stefano Oldani, Claudia Ravaglia, Patrizio Goti

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.

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

Conflict of interest statement

Harri Sintonen is the developer of the 15D and obtains royalties from its electronic versions. The other Authors have nothing to disclose.

Copyright © 2021 Elsevier Ltd. All rights reserved.

Figures

Fig. 1
Fig. 1
Health-related quality of life profiles at 3 months and 1 year after ICU discharge. Notes: asterisks highlight the dimensions significantly different between 3 months and 1 year. Abbreviations: Move – mobility; See – vision; Hear – hearing; Breath – breathing; Sleep – sleeping; Eat – eating; Speech – speech; Excret – excretion; Uact – usual activities; Mental – mental function; Disco – discomfort; Depr – depression; Distr – distress; Vital – Vitality; Sex – sexual activity.
Fig. 2
Fig. 2
Comparison of the 1-year health-related quality of life profiles clusters. Notes: the blue dashed lines highlight the significant differences between the partial recovery-mental and the partial recovery-physical groups. Abbreviations: Move – mobility; See – vision; Hear – hearing; Breath – breathing; Sleep – sleeping; Eat – eating; Speech – speech; Excret – excretion; Uact – usual activities; Mental – mental function; Disco – discomfort; Depr – depression; Distr – distress; Vital – Vitality; Sex – sexual activity. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
supplement Fig. 1
supplement Fig. 1

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