Four years after intensive care admission, patients who survived COVID-19-related acute respiratory distress syndrome (ARDS) continue to experience high rates of mortality and ongoing health challenges, according to new research published in Scientific Reports.
The study focused on a group of adults in Poland who were admitted to a temporary hospital between December 2020 and July 2021 due to severe SARS-CoV-2 infection that required invasive mechanical ventilation. Researchers collected baseline data such as age, comorbidities, laboratory markers, and the length of ICU stay. Primary outcomes were all-cause mortality at 30 days and four years post-ICU admission. Secondary outcomes included quality of life, functional status, sleep disturbance, cognitive complaints, financial burden, time to return to work, and indirect costs.
Out of 283 patients with COVID-19-associated ARDS who received ICU treatment, 29% died within the first month. Over the following four years, an additional 44 subjects died among those who survived past the first 30 days. The cumulative mortality rate reached 44.5% by four years after ICU admission.
The analysis found that patients who died within the first month tended to be older and had higher levels of certain laboratory markers like lactate dehydrogenase and white blood cell counts. They also had longer ICU stays and higher severity scores on the APACHE II scale compared with survivors at 30 days. For late deaths—those occurring after one month but before four years—older age was the only independent factor associated with increased risk.
Among survivors interviewed at four years (81 out of 157 eligible), many reported persistent health issues: "Four years after ICU admission, mortality remains strikingly high in ventilated COVID-19 ARDS patients, and many survivors continue to struggle with fatigue, insomnia, functional decline, and reduced quality of life." Of these respondents, 30% experienced functional limitations; nearly half reported insomnia; over a quarter suffered from significant fatigue; about one-fifth had moderate or worse pain or discomfort; and 15% had not returned to full-time employment.
Additionally, about two-fifths received rehabilitation services during recovery while three out of ten were rehospitalized at least once during follow-up. Median quality-adjusted life years for these survivors was estimated at 3.7 years. Those reporting cognitive difficulties or ongoing symptoms generally had lower quality-adjusted life expectancy than others.
Researchers noted that estimates might be influenced by survivorship bias since only about half of long-term survivors participated in interviews.
In summary, this single-center cohort study highlights continued vulnerability among individuals treated for severe COVID-19 ARDS in Poland: both early (within one month) and late (up to four years) mortality rates remain high despite advances in acute care management during the pandemic period. Persistent symptoms affecting daily function are common among those who survive long term.
