TY - JOUR
T1 - Life stressors significantly impact long-term outcomes and post-acute symptoms 12-months after COVID-19 hospitalization
AU - the NYU Neurology COVID-19 Study Team
AU - Frontera, Jennifer A.
AU - Sabadia, Sakinah
AU - Yang, Dixon
AU - de Havenon, Adam
AU - Yaghi, Shadi
AU - Lewis, Ariane
AU - Lord, Aaron S.
AU - Melmed, Kara
AU - Thawani, Sujata
AU - Balcer, Laura J.
AU - Wisniewski, Thomas
AU - Galetta, Steven L.
AU - Agarwal, Shashank
AU - Andino, Andres
AU - Arena, Vito
AU - Baskharoun, Samuel
AU - Bauman, Kristie
AU - Bell, Lena
AU - Berger, Stephen
AU - Bhagat, Dhristie
AU - Bokhari, Matthew
AU - Bondi, Steven
AU - Canizares, Melanie
AU - Chervinsky, Alexander
AU - Czeisler, Barry M.
AU - Dygert, Levi
AU - Fang, Taolin
AU - Flusty, Brent
AU - Friedman, Daniel
AU - Friedman, David
AU - Fuchs, Benjamin
AU - Granger, Andre
AU - Gratch, Daniel
AU - Gurin, Lindsey
AU - Gutman, Josef
AU - Hasanaj, Lisena
AU - Holmes, Manisha
AU - Horng, Jennifer
AU - Huang, Joshua
AU - Ishii, Haruki
AU - Jauregui, Ruben
AU - Ji, Yuan
AU - Kahn, D. Ethan
AU - Koch, Ethan
AU - Krieger, Penina
AU - Kvernland, Alexandra
AU - Lalchan, Rebecca
AU - Lillemoe, Kaitlyn
AU - Lin, Jessica
AU - Stainman, Rebecca S.
N1 - Publisher Copyright:
© 2022 Elsevier B.V.
PY - 2022/12/15
Y1 - 2022/12/15
N2 - Background: Limited data exists evaluating predictors of long-term outcomes after hospitalization for COVID-19. Methods: We conducted a prospective, longitudinal cohort study of patients hospitalized for COVID-19. The following outcomes were collected at 6 and 12-months post-diagnosis: disability using the modified Rankin Scale (mRS), activities of daily living assessed with the Barthel Index, cognition assessed with the telephone Montreal Cognitive Assessment (t-MoCA), Neuro-QoL batteries for anxiety, depression, fatigue and sleep, and post-acute symptoms of COVID-19. Predictors of these outcomes, including demographics, pre-COVID-19 comorbidities, index COVID-19 hospitalization metrics, and life stressors, were evaluated using multivariable logistic regression. Results: Of 790 COVID-19 patients who survived hospitalization, 451(57%) completed 6-month (N = 383) and/or 12-month (N = 242) follow-up, and 77/451 (17%) died between discharge and 12-month follow-up. Significant life stressors were reported in 121/239 (51%) at 12-months. In multivariable analyses, life stressors including financial insecurity, food insecurity, death of a close contact and new disability were the strongest independent predictors of worse mRS, Barthel Index, depression, fatigue, and sleep scores, and prolonged symptoms, with adjusted odds ratios ranging from 2.5 to 20.8. Other predictors of poor outcome included older age (associated with worse mRS, Barthel, t-MoCA, depression scores), baseline disability (associated with worse mRS, fatigue, Barthel scores), female sex (associated with worse Barthel, anxiety scores) and index COVID-19 severity (associated with worse Barthel index, prolonged symptoms). Conclusions: Life stressors contribute substantially to worse functional, cognitive and neuropsychiatric outcomes 12-months after COVID-19 hospitalization. Other predictors of poor outcome include older age, female sex, baseline disability and severity of index COVID-19.
AB - Background: Limited data exists evaluating predictors of long-term outcomes after hospitalization for COVID-19. Methods: We conducted a prospective, longitudinal cohort study of patients hospitalized for COVID-19. The following outcomes were collected at 6 and 12-months post-diagnosis: disability using the modified Rankin Scale (mRS), activities of daily living assessed with the Barthel Index, cognition assessed with the telephone Montreal Cognitive Assessment (t-MoCA), Neuro-QoL batteries for anxiety, depression, fatigue and sleep, and post-acute symptoms of COVID-19. Predictors of these outcomes, including demographics, pre-COVID-19 comorbidities, index COVID-19 hospitalization metrics, and life stressors, were evaluated using multivariable logistic regression. Results: Of 790 COVID-19 patients who survived hospitalization, 451(57%) completed 6-month (N = 383) and/or 12-month (N = 242) follow-up, and 77/451 (17%) died between discharge and 12-month follow-up. Significant life stressors were reported in 121/239 (51%) at 12-months. In multivariable analyses, life stressors including financial insecurity, food insecurity, death of a close contact and new disability were the strongest independent predictors of worse mRS, Barthel Index, depression, fatigue, and sleep scores, and prolonged symptoms, with adjusted odds ratios ranging from 2.5 to 20.8. Other predictors of poor outcome included older age (associated with worse mRS, Barthel, t-MoCA, depression scores), baseline disability (associated with worse mRS, fatigue, Barthel scores), female sex (associated with worse Barthel, anxiety scores) and index COVID-19 severity (associated with worse Barthel index, prolonged symptoms). Conclusions: Life stressors contribute substantially to worse functional, cognitive and neuropsychiatric outcomes 12-months after COVID-19 hospitalization. Other predictors of poor outcome include older age, female sex, baseline disability and severity of index COVID-19.
KW - Anxiety
KW - Cognition
KW - COVID-19
KW - Depression
KW - Disability
KW - Long-COVID
KW - Long-hauler
KW - Outcomes
KW - Post-acute sequelae of COVID
KW - Post-COVID syndrome
KW - Predictors
KW - Quality of life
KW - SARS-CoV-2
UR - https://www.scopus.com/pages/publications/85141793621
U2 - 10.1016/j.jns.2022.120487
DO - 10.1016/j.jns.2022.120487
M3 - Article
C2 - 36379135
AN - SCOPUS:85141793621
SN - 0022-510X
VL - 443
JO - Journal of the Neurological Sciences
JF - Journal of the Neurological Sciences
M1 - 120487
ER -