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A recent study published in Journal of Neurological Sciences reported that life stressors influence post-acute symptoms and long-term outcomes after hospitalization for coronavirus disease 2019 (COVID-19).
Post-acute sequelae of COVID-19 (PASC) have been observed in 25% to 69% of non-hospitalized patients and 33% to 90% of hospitalized patients. The variable prevalence may arise from differences in study design, symptoms, and time of assessment. Despite numerous studies reporting the prevalence of complications after COVID-19, there are limited data on predictors of long-term quality of life and cognitive and functional outcomes.
Study: Life stressors significantly impact long-term outcomes and post-acute symptoms 12 months after hospitalization for COVID-19. Image Credit: / Shutterstock
About the research
In the current study, researchers prospectively examined the influence of demographics, hospital clinical variables, pre-COVID-19 comorbid conditions, and life stressors on six-month and one-year outcome measures after a COVID-19 hospitalization. This observational study was conducted on patients hospitalized with COVID-19 from March 10 to May 20, 2022.
Follow-up interviews were conducted six months and one year after the initial diagnosis of COVID-19. Subjects were eligible if they were 18 years of age or older and were hospitalized with a positive SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) test, consenting to the follow-up interview. Individuals were excluded if they were assessed in the emergency department or outpatient setting.
Data on demographics, medical/neurological history, new in-hospital neurological or other complications, and medications used during acute COVID-19 were recorded. Severity of illness was classified based on ventilatory requirement and Sequential Organ Failure Assessment (SOFA) score. The modified Rankin Scale (mRS) was used to assess subjects’ baseline functional status before COVID-19.
Follow-up assessments were conducted via telephone interviews. Contact was attempted at six and 12 months after initial diagnosis of COVID-19. Functional status and disability status were assessed using the mRS; cognitive outcomes were examined with the Montreal Telephone Cognitive Assessment (t-MoCA).
The Barthel Index was used to assess activities of daily living (ADL), and self-reported health measures of depression, fatigue, sleep, and anxiety were collected by Neurological Quality of Life Short Forms (NeuroQoL). PASC results are defined as new/persistent symptoms occurring four weeks after COVID-19.
Findings
Follow-up interviews were attempted with 790 and 590 patients at six and 12 months, respectively. Of these, only 382 (48%) and 242 (41%) patients completed interviews at six and 12 months, respectively. Participants who completed only the six-month interview were older (mean age: 69 years) than those who completed the 12-month (65 years) interview.
No differences were found in gender, education level, race, pre-COVID-19 mRS scores, history of dementia/psychiatric illness, severity of COVID-19, and rates of neurologic complications during hospitalization between patients who completed six-month interviews and 12 months. Headache, anxiety, cognitive abnormalities, depression, fatigue, and sleep disturbances were common neurological symptoms at 12 months.
About 90% of patients at six months and 87% at 12 months showed abnormalities in at least one assessed metric, with mRS and t-MoCA abnormalities being the most prevalent. A small but significant correlation was observed between post-acute symptoms of COVID-19 and NeuroQoL anxiety scores ≥ 60. In addition, the authors noted an association of older age with poor mRS, t-MoCA scores and Barthel index in both present and with NeuroQoL scores for depression at one year.
Female gender was associated with increased anxiety scores at one year and poor Barthel scores at six and 12 months. Neurological complications, such as hypoxic-ischemic brain injury and toxic metabolic encephalopathy, strongly predicted poor Barthel index and mRS at six and 12 months and poorer fatigue and depression scores at one year. Poor SOFA and mechanical ventilation scores predicted poor Barthel index at six months.
The researchers found no consistent effect of the COVID-19 medications on the outcome measures. However, more than 50% of participants reported experiencing at least one life stressor in the month preceding the 12-month follow-up. New personal illness, social isolation, financial insecurity and illness/death of a close acquaintance are the most common life stressors.
The presence of stressors is strongly associated with post-acute symptoms of COVID-19 and poor NeuroQoL outcomes. There is a significant association between food and financial insecurity, new disability/death from a close contact, social isolation and personal illness with worse NeuroQoL scores. In contrast, new disability and personal illness were associated with the Barthel index and mRS.
Conclusions
In summary, the authors found independent associations of conventional predictors of poor outcomes, such as older age, poor pre-COVID-19 functional status, and disease severity, with worse t-MoCA, Barthel index, and mRS scores, and post-acute symptoms of COVID-19. Additionally, they found that life stressors negatively affected post-acute COVID-19 symptoms, depression, fatigue, sleep, and disability indicators. Taking life stressors into account, interventions aimed at alleviating life stress were associated with better cognitive, neuropsychiatric, and functional outcomes 12 months after hospitalization with COVID-19.
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