# Three-year functional, physical, and mental health outcomes after critical COVID-19: A prospective multicentre cohort study

## TL;DR

This study tracks the long-term recovery of critical COVID-19 survivors and finds that many experience worsening mental health and functional outcomes up to three years after ICU admission.

## Contribution

The study provides novel insights into the long-term recovery trajectory of critical COVID-19 survivors beyond the first year.

## Key findings

- Functional outcomes declined from 1 to 3 years, with incomplete recovery increasing from 32% to 45%.
- Mental health, fatigue, and post-traumatic stress worsened over the 3-year period.
- Younger age and higher frailty scores were independently associated with incomplete recovery at 3 years.

## Abstract

The understanding of recovery after critical COVID-19 beyond the first year is limited.

To describe changes in functional, physical, and mental health outcomes between 1 and 3 years among survivors of critical COVID-19 and to identify factors associated with incomplete recovery at 3 years.

A prospective multicentre cohort study of survivors of critical COVID-19 with follow-up at 1 and 3 years. The primary outcome was functional outcome, assessed using the Glasgow Outcome Scale-Extended (GOSE), which ranges from 1 to 8, with scores of 6 or less indicating incomplete recovery. Secondary outcomes included return-to-work, physical and mental Health-Related Quality of Life (HRQoL), life satisfaction, fatigue, psychological symptoms (anxiety, depression, post-traumatic stress disorder), and respiratory symptoms. Multivariable logistic regression was used to identify factors associated with incomplete recovery (GOSE ≤ 6) at 3 years.

Among 191 of 210 eligible participants, functional outcome declined from 1 to 3 years, and participants with incomplete recovery increased from 32% to 45%. Worse outcomes were observed in mental HRQoL, fatigue, depression, and post-traumatic stress, while return-to-work rates, physical HRQoL, life satisfaction, anxiety, and respiratory symptoms remained stable. Younger age [OR 0.70 (95% CI 0.54–0.91), p = 0.008] and higher Clinical Frailty Scale score [OR 1.54 (95% CI 1.04–2.28), p = 0.029] were independently associated with incomplete recovery at 3 years.

Survivors of critical COVID-19 experienced a decline in functional outcome and worsening mental health between 1 and 3 years after ICU admission. Younger and frail survivors may require increased attention and support.

ClinicalTrials.gov Identifier: NCT04974775, registered April 28, 2020.