Comparative Long-Term Outcomes of ICU and Non-ICU COVID-19 Patients: A Six-Month Follow-up study

Authors

  • Amna Haq Department of Medicine, Ziauddin University Hospital North campus, Karachi - Pakistan
  • Sabir Shaheen Department of Medicine, Ziauddin University Hospital North campus, Karachi - Pakistan
  • Khalid Rehman Department of Medicine, Ziauddin University Hospital North campus, Karachi - Pakistan
  • Nadeem Shah Department of Medicine, Ziauddin University Hospital North campus, Karachi - Pakistan

Keywords:

Respiratory Issues, COVID-19, ICU, COVID-19 Survivors

Abstract

Background: COVID-19 survivors often deal with long-term issues related to their lungs, overall function, and quality of life. Patients who needed ICU care during their acute infection may have worse outcomes than those treated outside the ICU. Understanding these differences is crucial for directing care and rehabilitation after discharge.  Objective: To investigate how COVID-19 affects lung structure, lung function, exercise capacity, and quality of life in patients discharged from ICU and medical wards.  Methodology: This study followed 110 adult COVID-19 patients who were discharged from ICU and non-ICU wards at a tertiary care hospital. At a six-month follow-up, all patients underwent high-resolution chest CT scans, pulmonary function tests, six-minute walk tests, and SF-36 quality-of-life assessments. Clinical data were analyzed using SPSS version 26.0. We used appropriate statistical tests to compare groups, setting significance at p<0.05.  Results: At six months, ICU patients had a higher rate of ongoing CT abnormalities (67.3% vs. 27.6%) and impaired lung function, especially reduced FVC and PEF values. The median distance walked in six minutes was significantly lower in the ICU group (435 m vs. 472 m), with 50% walking less than 80% of what was predicted. ICU patients also had lower SF-36 scores across most areas, showing a poorer quality of life.   Conclusion: COVID-19 patients who needed ICU care face more severe and lasting long-term issues than those not in the ICU. These issues include abnormal lung structure, reduced lung function, limited physical capacity, and lower quality of life. Early identification and focused rehabilitation are crucial. Ongoing follow-up care should be prioritized to enhance recovery outcomes.

References

World Health Organization. WHO Coronavirus (COVID-19) Dashboard. Available from URL: https://covid19.who.int/.

Khanam S. The Silent Pandemic Within: Unmasking the Mental Health struggles of healthcare workers on COVID-19 Facilities. Pak J Chest Med. 2021;27(3):114-6.

Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med. 2020;201(11):1430–1434. DOI: 10.1164/rccm.202003-0736LE.

Kazemi MA, Ghanaati H, Moradi B, Chavoshi M, Hashemi H, Hemmati S, et al. Prognostic factors of chest CT findings for ICU admission and mortality in patients with COVID-19 pneumonia. Iran J Radiol. 2020;17(4):e106879. DOI: 10.5812/iranjradiol.106879.

Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220–232. DOI: 10.1016/S0140-6736(20)32656-8.

Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology. 2021;299(1):E177–E186. DOI: 10.1148/radiol.2021203153.

Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J. 2020;55(6):2001217. DOI: 10.1183/13993003.01217-2020.

Germain A, Wakefield DB, Jablonowski K, Donahue M, Shenoy A, Borczuk A, et al. Risk factors and outcomes of long COVID: A prospective cohort study. Respir Med. 2022;191:106722. DOI: 10.1016/j.rmed.2021.106722.

Tabacof L, Tosto-Mancuso J, Wood J, Cortes M, Kontorovich A, McCarthy D, et al. Post-acute COVID-19 syndrome negatively impacts health and wellbeing despite less severe acute infection. J Med Virol. 2022;94(3):818–825. DOI: 10.1002/jmv.27339.

Herridge MS, Azoulay É. ICU survivors: come back in 5 years. Intensive Care Med. 2021;47(2):130–132. DOI: 10.1007/s00134-020-06247-2.

Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post-COVID-19 symptom burden: what is long-COVID and how should we manage it? Lung. 2021;199(2):113–119. DOI: 10.1007/s00408-021-00423-z.

Munblit D, Sigfrid L, Warner JO. Setting priorities to address research gaps in long-term COVID-19 outcomes in low- and middle-income countries. Lancet Reg Health West Pac. 2021;16:100258. DOI: 10.1016/j.lanwpc.2021.100258.

Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Persistent lung abnormalities on chest X-rays and CT scans of COVID-19 patients after discharge. Clin Imaging. 2021;72:4–9. DOI: 10.1016/j.clinimag.2020.11.004.

Myall KJ, Mukherjee B, Castanheira AM, Lam JL, Benedetti G, Mak SM, et al. Persistent post-COVID-19 interstitial lung disease: an observational study of corticosteroid treatment. Ann Am Thorac Soc. 2021;18(5):799–806. DOI: 10.1513/AnnalsATS.202008-1002OC.

Liu C, Ye L, Xia R, Zheng X, Yuan C, Wang Z, et al. Chest computed tomography and clinical follow-up of discharged COVID-19 patients. Ann Am Thorac Soc. 2020;17(10):1231–1237. DOI: 10.1513/AnnalsATS.202005-471OC.

Caruso D, Guido G, Zerunian M, Polici M, Pucciarelli F, Polidori T, et al. Post-Acute COVID-19 CT findings: Multicenter study. Radiology. 2021;299(3):E228–E231. DOI: 10.1148/radiol.2021203086.

Talman S, Boonman-de Winter LJ, De Mol M, Hoefman E, Van Etten RW, De Backer IC. Pulmonary function and health-related quality of life after COVID-19 pneumonia. Respir Med. 2021;176:106272. doi:10.1016/j.rmed.2020.106272.

Lerum TV, Aaløkken TM, Brønstad E, Aarli B, Ikdahl E, Lund KMA, et al. Dyspnoea, lung function and CT findings three months after hospital admission for COVID-19. Eur Respir J. 2021;57(4):2003448. DOI: 10.1183/13993003.03448-2020.

Bellan M, Soddu D, Balbo PE, Baricich A, Zeppegno P, Pirisi M, et al. Respiratory and psychophysical sequelae among COVID-19 survivors four months after discharge. JAMA Netw Open. 2021;4(1):e2036142. DOI:10.1001/jamanetworkopen.2020.36142.

Spielmanns M, Pekacka-Egli AM, Schoendorf S, Windisch W, Hermann M. Effects of a comprehensive pulmonary rehabilitation in severe post-COVID-19 patients. Int J Environ Res Public Health. 2022;19(9):5401. DOI: 10.3390/ijerph19095401.

Xiong Q, Xu M, Li J, Liu Y, Zhang J, Xu Y, et al. Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study. Clin Microbiol Infect. 2021;27(1):89–95. DOI: 10.1016/j.cmi.2020.09.023.

Carfì A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603–605. DOI: 10.1001/jama.2020.12603.

Fernández-de-las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Cuadrado ML, Florencio LL. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized patients. Eur J Intern Med. 2021;92:55–70. DOI: 10.1016/j.ejim.2021.06.009.

Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection. J Med Virol. 2021;93(2):1013–1022. DOI: 10.1002/jmv.26368.

Downloads

Published

2024-12-02

How to Cite

Haq, A. ., Shaheen, S. ., Rehman, K. ., & Shah, N. . (2024). Comparative Long-Term Outcomes of ICU and Non-ICU COVID-19 Patients: A Six-Month Follow-up study. Pakistan Journal of Chest Medicine, 30(4), 462–470. Retrieved from http://www.pjcm.net/index.php/pjcm/article/view/987

Issue

Vol. 30 No. 4 (2024)

Section

Original Article

License

Copyright (c) 2024 Pakistan Journal of Chest Medicine

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.