Long-term health outcomes of COVID-19 in ICU- and non-ICU-treated patients up to 2 years after hospitalization: a longitudinal cohort study (CO-FLOW)
Julia C. Berentschot, L. Martine Bek, Majanka H. Heijenbrok‐Kal, Jasper van Bommel, Gerard M. Ribbers, J.G. Aerts, Merel E. Hellemons, H. J. G. van den Berg-Emons, Joachim G.J.V. Aerts, L. Martine Bek, Julia C. Berentschot, Rita J. G. van den Berg-Emons, Sieshem Bindraban, Wouter J. B. Blox, Jasper van Bommel, Shai A. Gajadin, Michel E. van Genderen, Diederik A. M. P. J. Gommers, Majanka H. Heijenbrok‐Kal, Merel E. Hellemons, Roxane Heller, Erwin Ista, Stephanie van Loon-Kooij, Chantal J. C. Luijkx, Rutger Osterthun, Laurien Oswald, Gerard M. Ribbers, Ronald N. van Rossem, Herbert J. van de Sande, Robert van der Stoep, Janette J. Tazmi-Staal, Markus P. J. M. Wijffels, Eva G. Willems
Abstract
BACKGROUND: Many patients hospitalized for COVID-19 experience long-term health problems, but comprehensive longitudinal data up to 2 years remain limited. We aimed to (1) assess 2-year trajectories of health outcomes, including comparison between intensive care unit (ICU) treated and non-ICU-treated patients, and (2) identify risk factors for prominent health problems post-hospitalization for COVID-19. METHODS: The CO-FLOW multicenter prospective cohort study followed adults hospitalized for COVID-19 at 3, 6, 12, and 24 months post-discharge. Measurements included patient-reported outcomes (a.o., recovery, symptoms, fatigue, mental health, sleep quality, return to work, health-related quality of life [HRQoL]), and objective cognitive and physical tests. Additionally, routine follow-up data were collected. RESULTS: 650 patients (median age 60.0 [IQR 53.0-67.0] years; 449/650 [69%] male) surviving hospitalization for COVID-19 were included, of whom 273/650 (42%) received ICU treatment. Overall, outcomes improved over time. Nonetheless, 73% (322/443) of patients had not completely recovered from COVID-19, with memory problems (274/443; 55%), concentration problems (259/443; 52%), and dyspnea (251/493; 51%) among most frequently reported symptoms at 2 years. Moreover, 61% (259/427) had poor sleep quality, 51% (222/433) fatigue, 23% (102/438) cognitive failures, and 30% (65/216) did not fully return to work. Objective outcome measures showed generally good physical recovery. Most outcomes were comparable between ICU- and non-ICU-treated patients at 2 years. However, ICU-treated patients tended to show slower recovery in neurocognitive symptoms, mental health outcomes, and resuming work than non-ICU-treated patients, while showing more improvements in physical outcomes. Particularly, female sex and/or pre-existing pulmonary disease were major risk factors for poorer outcomes. CONCLUSIONS: 73% (322/443) of patients had not completely recovered from COVID-19 by 2 years. Despite good physical recovery, long-term neurocognitive complaints, dyspnea, fatigue, and impaired sleep quality persisted. ICU-treated patients showed slower recovery in neurocognitive and mental health outcomes and resumption of work. Tailoring long-term COVID-19 aftercare to individual residual needs is essential. Follow-up is required to monitor further recovery. TRIAL REGISTRATION: NL8710, registration date 12-06-2020.