# Health-related quality of life trajectories one year after COVID-19–induced ARDS: A secondary analysis of the CONFIDENT trial

## TL;DR

This study tracks the recovery of health-related quality of life in ARDS survivors over one year and finds that longer ICU and hospital stays are linked to better outcomes.

## Contribution

The study identifies duration of ICU and hospital stays as key factors in long-term recovery of ARDS survivors, independent of age or frailty.

## Key findings

- Health-related quality of life improved from day 90 to one year post-ICU but remained below pre-ICU levels.
- 38% and 43% of patients showed no improvement or decline in quality of life measures over the year.
- Shorter durations of mechanical ventilation and ICU stays were associated with poorer recovery.

## Abstract

Survivors of ARDS are at risk of persistent physical
and psychological impairments, yet reliable prognostic factors for long-term
recovery are poorly defined. The aims of the study were to describe changes in
health-related quality of life (HRQoL) during the year after discharge from
intensive care unit (ICU) in a cohort of ARDS survivors, and to identify factors
associated with a favorable recovery trajectory.

This planned secondary analysis used prospectively
collected data from the multicenter randomized CONFIDENT trial that enrolled 475
mechanically ventilated COVID-19 ARDS patients. Patients who completed
interviews at both day 90 (D90) and one year (Y1) were included. HRQoL was
assessed using the EQ-5D-5L utility score (EQ-score) and visual analog scale
(EQ-VAS). Baseline status, disease severity, and ICU characteristics were
analyzed for associations with HRQoL changes.

156 survivors completed follow-up at both D90 and Y1.
EQ-score and EQ-VAS significantly improved between D90 and Y1 (p < 0.0001 and
p = 0.0002 respectively), but both remained lower than pre-ICU status. Notably,
38 and 43% of patients showed stagnation or deterioration in EQ-score and EQ-VAS
over the year. Longer durations of mechanical ventilation, ICU stay, and
hospital stay were associated with greater EQ-score and EQ-VAS recovery, whereas
shorter stays were linked to less improvement (respectively p = 0.0002 and
p = 0.025, p = 0.0002 and p = 0.0035, p = 0.0020 and p = 0.026). Demographics
and pre-admission frailty showed no impact on the recovery
trajectory.

In this multicenter cohort of ARDS survivors, patients
with shorter durations of mechanical ventilation, ICU and hospital stay
experienced poorer HRQoL recovery, independently of baseline characteristics
such as age or frailty.

Clinicaltrials.gov registration number NCT04558476.
Registered 14 September 2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476