Functional capacity, activities of daily living and quality of life in survivors of severe acute respiratory syndrome (SARS) due to COVID-19 after 3 years of hospital discharge

Abstract

Introduction: COVID-19 has caused >7 million deaths worldwide since its onset in 2019. Although the severity of the disease has varied throughout the pandemic, COVID-19-related critical illness persists. Survivors of COVID-19 critical illness may be left with sequelae of the SARS-CoV-2 virus and long-term effects of critical illness including post-intensive care syndrome. Given the complexity and heterogeneity of COVID-19 critical illness, predictive models of symptom persistence may aid in the assessment and treatment of survivors, including public policies that integrate domains of structure, activity level, and participation of survivors.
Methods: Cross-sectional study that evaluated 102 volunteers who survived the severe form of COVID-19 and required hospitalization. All volunteers were clinically and functionally evaluated by the 6MWT, Glittre ADL test (TGlittre), handgrip dynamometry, and the SF-36 questionnaire after 3 years of hospital discharge. Results: The sample consisted of adults and elderly individuals (62.2±11.14 years), with a male majority (n=71; 69.6%) with lung function showing mild restrictive behavior (median, % [IQR] of FVC, FEV1/FVC and FEV1 were 68 [12.8]; 83 [12.4]; 69 [15.9], respectively). Of the 102 volunteers, 64 (62.74%) required invasive mechanical ventilation (IMV), with an IH time of 20.03±1.04 and IMV time of 13.02±9.99 days. We observed a significantly higher prevalence of functional limitation (57.8% [n=37] vs 5.88% [n=6]; p<0.001) in patients who were mechanically ventilated, with an odds ratio of 4.82, which represents that mechanically ventilated patients are four times more likely to have functional limitation 36 months (3 years) after hospital discharge and a relative risk of 1.89. Our results also demonstrate that mechanically ventilated patients had a lower 6MWD and longer time in TGlittree, 36 months after hospital discharge (6MWD: median 395 [12.80] vs 327 [7.20] m, p < 0.001); TTGlittre: 3.4 [0.20] vs 4.12 [0.60] min, p < 0.001). In addition to the previously described reduction in functional capacity, we observed that mechanically ventilated patients had worse overall HRQoL (SF-36 HRQoL: median [IQR] 68[15.00] vs 60[12.00], p<0.03) and worse HRQoL in the physical fitness domain (SF-36 physical function: median [IQR] 68[15.00] vs 50[10.00], p<0.001), 36 months after hospital discharge. Conclusion: 3 years after hospital discharge, survivors of the severe form of COVID-19 who required the use of invasive ventilatory support had a higher prevalence of reduced functional capacity, lower exercise tolerance and limitation for activities of daily living with worse quality of life.