Long-term reduced functional capacity and quality of life in hospitalized COVID-19 patients

Anderson Donelli da Silveira; Fernando Luis Scolari; Marina Petersen Saadi; Darshan H Brahmbhatt; Mauricio Milani; Juliana Goulart Prata Oliveira Milani; Gerson Cipriano Junior; Ivaine Tais Sauthier Sartor; Gabriela Oliveira Zavaglia; Maiko Luis Tonini; Marcela Santos Correa da Costa; Marcelo Comerlato Scotta; Renato T Stein; Regis Goulart Rosa

doi:10.3389/fmed.2023.1289454

Long-term reduced functional capacity and quality of life in hospitalized COVID-19 patients

Front Med (Lausanne). 2024 Mar 6:10:1289454. doi: 10.3389/fmed.2023.1289454. eCollection 2023.

Authors

Anderson Donelli da Silveira^{1

2}, Fernando Luis Scolari^{1

2

3

4}, Marina Petersen Saadi^{1

2}, Darshan H Brahmbhatt³, Mauricio Milani^{5

6}, Juliana Goulart Prata Oliveira Milani^{5

6}, Gerson Cipriano Junior⁶, Ivaine Tais Sauthier Sartor⁴, Gabriela Oliveira Zavaglia⁴, Maiko Luis Tonini⁷, Marcela Santos Correa da Costa⁸, Marcelo Comerlato Scotta⁴, Renato T Stein⁴, Regis Goulart Rosa⁴

Affiliations

¹ Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
² Postgraduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Rio de Janeiro, Brazil.
³ Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University of Toronto, Toronto, ON, Canada.
⁴ Social Responsibility, Hospital Moinhos de Vento, Porto Alegre, Brazil.
⁵ Hasselt University, REVAL/BIOMED, Hasselt, Belgium.
⁶ Health Sciences and Technologies Graduate Program, University of Brasilia (UnB), Brasilia, Brazil.
⁷ General Coordination, Chronic and Airborne Disease Surveillance Coordination, Health Surveillance Secretariat, Brazilian Ministry of Health, Brasilia, Brazil.
⁸ General Coordination, National Immunization Program, Health Surveillance Secretariat, Brazilian Ministry of Health, Brasilia, Brazil.

Abstract

Background: Persistent symptoms and exercise intolerance have been reported after COVID-19, even months after the acute disease. Although, the long-term impact on exercise capacity and health-related quality of life (HRQoL) is still unclear.

Research question: To assess the long-term functional capacity and HRQoL in patients hospitalized due to COVID-19.

Study design and methods: This is a prospective cohort study, conducted at two centers in Brazil, that included post-discharge COVID-19 patients and paired controls. The cohort was paired by age, sex, body mass index and comorbidities, using propensity score matching in a 1:3 ratio. Patients were eligible if signs or symptoms suggestive of COVID-19 and pulmonary involvement on chest computed tomography. All patients underwent cardiopulmonary exercise testing (CPET) and a HRQoL questionnaire (SF-36) 6 months after the COVID-19. The main outcome was the percentage of predicted peak oxygen consumption (ppVO2). Secondary outcomes included other CPET measures and HRQoL.

Results: The study sample comprised 47 post-discharge COVID-19 patients and 141 healthy controls. The mean age of COVID-19 patients was 54 ± 14 years, with 19 (40%) females, and a mean body mass index of 31 kg/m² (SD, 6). The median follow-up was 7 months (IQR, 6.5-8.0) after hospital discharge. PpVO2 in COVID-19 patients was lower than in controls (83% vs. 95%, p = 0.002) with an effect size of 0.38 ([95%CI], 0.04-0.70). Mean peak VO2 (22 vs. 25 mL/kg/min, p = 0.04) and OUES (2,122 vs. 2,380, p = 0.027) were also reduced in the COVID-19 patients in comparison to controls. Dysfunctional breathing (DB) was present in 51%. HRQoL was significantly reduced in post COVID patients and positively correlated to peak exercise capacity.

Interpretation: Hospitalized COVID-19 patients presented, 7 months after discharge, with a reduction in functional capacity and HRQoL when compared to historical controls. HRQoL were reduced and correlated with the reduced peak VO2 in our population.

Keywords: COVID-19; CPET cardiopulmonary exercise testing; HRQOL; functional capacity; long COVID.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Brazilian Ministry of Health, through the Institutional Development Program of the Brazilian National Health System (PROADI-SUS) in collaboration with Hospital Moinhos de Vento. Financial partial support for this work was also provided by public research grants and scholarships from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES). The authors also received scholarships from the Special Research Fund (BOF) from Hasselt University/Belgium (Number: BOF23DOCBL10 and BOF23KV10). This study was partially funded by the Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior (CAPES) - Brasil - Finance Code 001. This study was partially funded by Hospital de Clínicas de Porto Alegre (Fundo de Incentivo à Pesquisa e Eventos; FIPE/HCPA).