key: cord-0695173-j2mlg1n6
authors: Rosa Ramos, Joao Gabriel; Laporte, Larrie Rabelo; Ribeiro de Souza, Flaviane; Andrade, Lucas Freire de
title: Functional outcomes of severe COVID-19 patients after a post-acute care hospitalization
date: 2021-09-17
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2021.09.007
sha: b5f7989f9750bf76415f5cd79e9be7419d989263
doc_id: 695173
cord_uid: j2mlg1n6

nan

Patients hospitalized for severe coronavirus-disease 2019 (COVID-19) may present with persistent 2 symptoms and functional impairment for months after infection 1 2 . A proportion of those patients 3 may need further hospitalization for rehabilitation or proper care transition 3 . However, little is 4 known about outcomes after such hospitalizations 4 . We assessed long-term outcomes of patients 5 admitted to a post-acute care facility (PACF) after a severe COVID-19 hospitalization. 6

Our study evaluated a cohort of patients with severe COVID-19 treated at a 60-bed private PACF in 7

Brazil. Data was collected at PACF admission, discharge, and follow-up by telephone. Functional 8 status was assessed by modified Barthel index (MBI: 20-100 points) 5 . Mental health symptoms and 9 quality of life were assessed by the Hospital Anxiety and Depression Scale (HADS) and the EQ-5D-10 3L score, respectively. Categorical variables with repeated measures were compared with 11

Friedman test and a p-value<0.05 was considered significant. This study was approved by 12 institutional review board and informed consent was obtained from participants. 13

We report the first 100 patients admitted at the PACF after severe COVID-19 from April, 2020 to 14 April, 2021. Follow-up was performed until June 8 th , 2021. 15

Patients were admitted to the PACF from 12 different hospitals, with a median(IQR) of 33(23-42) 16 days from symptoms onset. Mean age was 65±15 years and 63(63%) were male. Mean Charlson 17 comorbidity index was 2.5±1.9 and 86(86%) were independent for all activities of daily living 18 before hospitalization. Patients were hospitalized for 32(24-42) days before transition to PACF and 19 91(91%) were admitted in the intensive care unit, 79(79%) received invasive mechanical 20 ventilation and 3(3%) received extracorporeal membrane oxygenation during the original 21 hospitalization. 22

At admission to the PACF, 41(41%) patients were in use of tracheostomy tube, 52(52%) with tube 23 feeding, 63(63%) needed oxygen supplementation and 5(5%) were mechanically ventilated. 24

Median PACF length of stay was 28(15-46) days. Nine (9%) patients were readmitted to an acute 25 care hospital due to clinical deterioration and 12(12%) patients died during PACF hospitalization. 26

At follow-up, for a median(IQR) of 54(40-91) days after PACF discharge and 142(109-276) days 27 after symptoms onset, of the 79 patients discharged alive, 2 (2.5%) died, 12 (15%) were 28 readmitted to an acute hospital and 70 (88%) reported at least one persistent symptom (table 1) Overall, in this cohort of relatively young and previously fit patients admitted to PACF after severe 37 COVID-19, functional status was severely impaired at PACF admission, improved at discharge and 38 was sustained during follow-up, but there was a high burden of symptoms and perceived lower 39 quality of life among survivors. 40 EQ5D-3L health state index scores generally range from less than 0 (where 0 is a health state 58 equivalent to death; negative values are valued as worse than death) to 1 (perfect health) 59 60 HADS , Hospital Anxiety and Depression Scale is assessed in two dimensions: anxiety and 61 depression. Each dimension scores from 0 to 21 (higher scores indicating greater chance of 62 symptoms). A score above 9 is usually interpreted as a cutoff. 63 J o u r n a l P r e -p r o o f

Persistent Symptoms in Patients After Acute COVID-19

High-dimensional characterization of post-acute sequelae of COVID-19. 44

Sixty-Day Outcomes Among Patients Hospitalized With 46 COVID-19

Do Patients With COVID-19 Benefit from Rehabilitation? 48 Functional Outcomes of the First 100 Patients in a COVID-19 Rehabilitation Unit

Improving the sensitivity of the Barthel Index for stroke 51 rehabilitation

Figure 1. Functional status, as measured by the modified Barthel index (MBI) at post-acute care 64 facility (PACF) admission, discharge and after follow-up (p<0.001). The MBI was categorized as 65 total dependence if equal to 20; severe dependence, if between 21 and 60; moderate 66 dependence, if between 61 and 90