Six-Month Outcome in Survivors of COVID-19 Associated Acute Respiratory Distress Syndrome

BACKGROUND: Survivors of acute respiratory distress syndrome (ARDS) frequently experience long-lasting physical, cognitive and mental impairments. We aimed to characterize persisting disabilities in survivors of COVID-19-associated ARDS at three months after hospital discharge. METHODS: Patients were assessed serially with a structured telephone interview, complete clinical chart and X-ray review and in-person visit at a follow-up clinic. FINDINGS: Of the 93 survivors,  3 (3%) were lost to follow-up, 8 (8%) were totally dependent and 82 were independent in activities of daily living (ADL). Of these 82 patients, 25 had reached independence at hospital discharge and refused further evaluation, whereas 57 consented to participate in the follow-up visit. Two patients (3·5%) had significant muscle weakness, and 20 (35%) had critical illness neuropathy or myopathy. Median distance walked in 6 minutes, and median scores of SF-36 Physical functioning and Role limitations due to physical problems were normal. Severe fatigue was reported by 36% of patients. Thirty-six patients (63%) returned to previous work. Cognitive and mental function were normal or only mildly impaired in 96% of patients.  Median SF-36 physical and mental component scores were 86% and 100% of predicted values. Interstitial and alveolar chest-X ray abnormalities were found in 30 of 43 patients. Spirometry showed restrictive or obstructive patterns in 9 of 17 patients and altered DLCO in 10. INTERPRETATION: Survivors of COVID-19-associated ARDS have fast recovery of physical functioning at the body level, of the whole person and as participation in a social context. Cognitive and mental function, quality of life and independence in ADL are also rapidly re-established. TRIAL REGISTRATION: NCT04608994 FUNDING: The study was funded by FONDAZIONE ALESSANDRA BONO ONLUS, a non-profit organization - Via Fornaci 33, 25040 Corte Franca (BS), Italy https://www.fondazionealessandrabono.it DECLARATION OF INTERESTS: All authors declare no conflicts of interest. ETHICS APPROVAL STATEMENT: The Brescia Ethics committee approved the study (NP 2595).