Long-Term Outcomes of Patients With COVID-19 Who Are Critically Ill

Abstract

Background

Survivors of critical illness are susceptible to long-term functional impairments after admission to an ICU. During the COVID-19 pandemic, the number of patients admitted to an ICU with SARS-CoV-2 infection surged. The long-term consequences of critical illness resulting from COVID-19 illness remain unclear.

Research Question

What are the long-term outcomes of adult patients admitted to an ICU for COVID-19?

Study Design and Methods

We searched Ovid MEDLINE and EMBASE using subject heading and free-text terms related to long-term outcomes of critically ill patients with COVID-19. We included all articles that reported original data on outcomes from 90 days onward for adult patients admitted to an ICU for COVID-19. Data extracted included study details, patient characteristics, outcomes reported, measurement tools used, and timing of assessment.

Results

A total of 14,882 studies were screened, from which 134 studies fulfilled the selection criteria. Follow-up time points ranged from 90 days to 2 years after critical illness. Mortality after hospitalization was the most reported outcome (n = 60), with the general ICU cohort having an aggregate mortality rate of 35.5% (95% CI, 34.7%-36.2%) at 90 days and 31.6% (95% CI, 30.9%-32.4%) at 6 months. A plethora of other outcomes were assessed, including psychologic function and mental health (n = 49), persistent symptoms (n = 47), quality of life (n = 47), physical function (n = 33), and cognitive function (n = 31). For each outcome, different measurement tools were used, making data synthesis across studies difficult.

Interpretation

Important evidence gaps remain regarding the long-term health outcomes and health care needs for survivors of critical COVID-19 illness. This review found that mortality was the most reported long-term outcome. Significant heterogeneity was evident across studies in terms of outcomes assessed, measurement instruments used, and the duration of follow-up. Future research requires increased consistency in outcomes assessed and measurement tools to inform clinical practice.