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

Rationale: 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. Methods: 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. Results: 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. Conclusion: 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. Trial registration: Clinicaltrials.gov registration number NCT04558476. Registered 14 September 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04558476.