Association between acute disease severity and one-year quality of life among post-hospitalisation COVID-19 patients: Coalition VII prospective cohort study

Abstract

Purpose: To assess the association between acute disease severity and 1-year quality of life in patients discharged after hospitalisation due to coronavirus disease 2019 (COVID-19). Methods: We conducted a prospective cohort study nested in 5 randomised clinical trials between March 2020 and March 2022 at 84 sites in Brazil. Adult post-hospitalisation COVID-19 patients were followed for 1 year. The primary outcome was the utility score of EuroQol fve-dimension three-level (EQ-5D-3L). Secondary outcomes included allcause mortality, major cardiovascular events, and new disabilities in instrumental activities of daily living. Adjusted generalised estimating equations were used to assess the association between outcomes and acute disease sever‑ ity according to the highest level on a modifed ordinal scale during hospital stay (2: no oxygen therapy; 3: oxygen by mask or nasal prongs; 4: high-fow nasal cannula oxygen therapy or non-invasive ventilation; 5: mechanical ventilation). Results: 1508 COVID-19 survivors were enrolled. Primary outcome data were available for 1156 participants. At 1 year, compared with severity score 2, severity score 5 was associated with lower EQ-5D-3L utility scores (0.7 vs 0.84; adjusted diference,−0.1 [95% CI−0.15 to−0.06]); and worse results for all-cause mortality (7.9% vs 1.2%; adjusted diference, 7.1% [95% CI 2.5%–11.8%]), major cardiovascular events (5.6% vs 2.3%; adjusted diference, 2.6% [95% CI 0.6%–4.6%]), and new disabilities (40.4% vs 23.5%; adjusted diference, 15.5% [95% CI 8.5%–22.5]). Severity scores 3 and 4 did not difer consistently from score 2. Conclusions: COVID-19 patients who needed mechanical ventilation during hospitalisation have lower 1-year qual‑ ity of life than COVID-19 patients who did not need mechanical ventilation during hospitalisation.