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6. Surviving COVID-19: patients' experiences of care and path to recovery.

Author

Eklund, Rakel, Hjelmfors, Lisa, Nyquist, Sophia, Sveen, Josefin, Hultström, Michael, Lipcsey, Miklos, Frithiof, Robert, Wallin, Ewa, Larsson, Ing-Marie, Arnberg, Filip K., and Orwelius, Lotti

Subjects
ACADEMIC medical centers, PATIENTS, PATIENT safety, RESEARCH funding, QUALITATIVE research, EMPIRICAL research, HOSPITAL admission & discharge, FATIGUE (Physiology), INTERVIEWING, PILOT projects, DISCHARGE planning, EMOTIONS, FAMILY attitudes, THEMATIC analysis, CONVALESCENCE, INTENSIVE care units, RESEARCH, LOVE, RESEARCH methodology, SOCIAL support, COVID-19, PATIENTS' attitudes, SOCIAL isolation, FRIENDSHIP, WELL-being
Abstract

Purpose: To examine patients' experiences of receiving care on an ICU for COVID-19 and the subsequent rehabilitation process. Methods: An explorative and inductive design was used. Participants were recruited from two university hospitals in Sweden. Patients admitted to the ICU due to COVID-19 from March 2020 to April 2021, who enrolled in the ICU follow-up, and understood and spoke Swedish were invited to participate. In total, 20 participants completed a semi-structured interview, of whom 18 were included in the thematic analysis. Results: The analysis resulted in two themes: "An isolated world with silver linings" and "Recovery in the wake of the pandemic". Findings show that patients cared for on an ICU for COVID-19 during the pandemic felt safe but experienced a sense of vulnerability. After discharge, physical rehabilitation was a slow process with frustrating day-to-day fluctuations. Mentally, participants felt isolated, fatigued, and emotionally sensitive. Patients reported that love and support from family and friends were crucial for the recovery process. Conclusions: This study highlights the challenges of recovering from COVID-19, emphasizing the importance of continued support from health care, public services, family and friends. It provides important insights into patients' experiences and can inform future healthcare strategies and policies. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Dehydration is associated with production of organic osmolytes and predicts physical long-term symptoms after COVID-19: a multicenter cohort study

Author

Hultström, Michael, Lipcsey, Miklos, Morrison, Dave R., Nakanishi, Tomoko, Butler-Laporte, Guillaume, Chen, Yiheng, Yoshiji, Satoshi, Forgetta, Vincenzo, Farjoun, Yossi, Wallin, Ewa, Larsson, Ing-Marie, Larsson, Anders, Marton, Adriana, Titze, Jens Marc, Nihlén, Sandra, Richards, J. Brent, and Frithiof, Robert

Published
2022
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9. Body mass index is associated with pulmonary gas and blood distribution mismatch in COVID-19 acute respiratory failure : A physiological study

Author

Bjarnadóttir, Kristín J., Perchiazzi, Gaetano, Sidenbladh, Caroline Lördal, Larina, Aleksandra, Wallin, Ewa, Larsson, Ing-Marie, Franzén, Stephanie, Larsson, Anders, Sousa, Mayson L. A., Segelsjö, Monica, Hansen, Tomas, Frithiof, Robert, Hultström, Michael, Lipcsey, Miklós, Pellegrini, Mariangela, Bjarnadóttir, Kristín J., Perchiazzi, Gaetano, Sidenbladh, Caroline Lördal, Larina, Aleksandra, Wallin, Ewa, Larsson, Ing-Marie, Franzén, Stephanie, Larsson, Anders, Sousa, Mayson L. A., Segelsjö, Monica, Hansen, Tomas, Frithiof, Robert, Hultström, Michael, Lipcsey, Miklós, and Pellegrini, Mariangela

Abstract

Background: The effects of obesity on pulmonary gas and blood distribution in patients with acute respiratory failure remain unknown. Dual-energy computed tomography (DECT) is a X-ray-based method used to study regional distribution of gas and blood within the lung. We hypothesized that 1) regional gas/blood mismatch can be quantified by DECT; 2) obesity influences the global and regional distribution of pulmonary gas and blood; 3) regardless of ventilation modality (invasive vs. non-invasive ventilation), patients’ body mass index (BMI) has an impact on pulmonary gas/blood mismatch. Methods: This single-centre prospective observational study enrolled 118 hypoxic COVID-19 patients (92 male) in need of respiratory support and intensive care who underwent DECT. The cohort was divided into three groups according to BMI: 1. BMI<25 kg/m2 (non-obese), 2. BMI = 25–40 kg/m2 (overweight to obese), and 3. BMI>40 kg/m2 (morbidly obese). Gravitational analysis of Hounsfield unit distribution of gas and blood was derived from DECT and used to calculate regional gas/blood mismatch. A sensitivity analysis was performed to investigate the influence of the chosen ventilatory modality and BMI on gas/blood mismatch and adjust for other possible confounders (i.e., age and sex). Results: 1) Regional pulmonary distribution of gas and blood and their mismatch were quantified using DECT imaging. 2) The BMI>40 kg/m2 group had less hyperinflation in the non-dependent regions and more lung collapse in the dependent regions compared to the other BMI groups. In morbidly obese patients, gas and blood were more evenly distributed; therefore, the mismatch was lower than in other patients (30% vs. 36%, p < 0.05). 3) An increase in BMI of 5 kg/m2 was associated with a decrease in mismatch of 3.3% (CI: 3.67% to −2.93%, p < 0.05). Neither the ventilatory modality nor age and sex affected the gas/blood mismatch (p > 0.05). Conclusion: 1) In a hypoxic COVID-19 population needing intens

Published
2024
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11. Estimated Global Proportions of Individuals with Persistent Fatigue, Cognitive, and Respiratory Symptom Clusters Following Symptomatic COVID-19 in 2020 and 2021

Author

Wulf Hanson, Sarah, Abbafati, Cristiana, Aerts, Joachim G, Al-Aly, Ziyad, Ashbaugh, Charlie, Ballouz, Tala, Blyuss, Oleg, Bobkova, Polina, Bonsel, Gouke, Borzakova, Svetlana, Buonsenso, Danilo, Butnaru, Denis, Carter, Austin, Chu, Helen, De Rose, Cristina, Diab, Mohamed Mustafa, Ekbom, Emil, El Tantawi, Maha, Fomin, Victor, Frithiof, Robert, Gamirova, Aysylu, Glybochko, Petr V, Haagsma, Juanita A, Haghjooy Javanmard, Shaghayegh, Hamilton, Erin B, Harris, Gabrielle, Heijenbrok-Kal, Majanka H, Helbok, Raimund, Hellemons, Merel E, Hillus, David, Huijts, Susanne M, Hultström, Michael, Jassat, Waasila, Kurth, Florian, Larsson, Ing-Marie, Lipcsey, Miklós, Liu, Chelsea, Loflin, Callan D, Malinovschi, Andrei, Mao, Wenhui, Mazankova, Lyudmila, Mcculloch, Denise, Menges, Dominik, Mohammadifard, Noushin, Munblit, Daniel, Nekliudov, Nikita A, Ogbuoji, Osondu, Osmanov, Ismail M, Peñalvo, José L, Petersen, Maria Skaalum, Puhan, Milo A, Rahman, Mujibur, Rass, Verena, Reinig, Nickolas, Ribbers, Gerard M, Ricchiuto, Antonia, Rubertsson, Sten, Samitova, Elmira, Sarrafzadegan, Nizal, Shikhaleva, Anastasia, Simpson, Kyle E, Sinatti, Dario, Soriano, Joan B, Spiridonova, Ekaterina, Steinbeis, Fridolin, Svistunov, Andrey A, Valentini, Piero, van de Water, Brittney J, van den Berg-Emons, Rita, Wallin, Ewa, Witzenrath, Martin, Yifan, Wu, Hanzhang, Xu, Zoller, Thomas, Adolph, Christopher, Albright, James, Amlag, Joanne O, Aravkin, Aleksandr Y, Bang-Jensen, Bree L, Bisignano, Catherine, Castellano, Rachel, Castro, Emma, Chakrabarti, Suman, Collins, James K, Dai, Xiaochen, Daoud, Farah, Dapper, Carolyn, Deen, Amanda, Duncan, Bruce B, Erickson, Megan, Ewald, Samuel B, Ferrari, Alize J, Flaxman, Abraham D, Fullman, Nancy, Gamkrelidze, Amiran, Giles, John R, Guo, Gaorui, Hay, Simon I, Jiawei, He, Helak, Monika, Hulland, Erin N, Kereselidze, Maia, Krohn, Kris J, Lazzar-Atwood, Alice, Lindstrom, Akiaja, Lozano, Rafael, Malta, Deborah Carvalho, Månsson, Johan, Mantilla Herrera, Ana M, Mokdad, Ali H, Monasta, Lorenzo, Nomura, Shuhei, Pasovic, Maja, Pigott, David M, Reiner, Robert C, Reinke, Grace, Ribeiro, Antonio Luiz P, Santomauro, Damian Francesco, Sholokhov, Aleksei, Spurlock, Emma Elizabeth, Walcott, Rebecca, Walker, Ally, Wiysonge, Charles Shey, Zheng, Peng, Bettger, Janet Prvu, Murray, Christopher J L, Vos, Theo, Pulmonary Medicine, Public Health, and Rehabilitation Medicine

Subjects
Adult, Male, Internationality, long covid, Adolescent, Pain, Global Health, Cov-2, proportion of polpulation, Young Adult, Post-Acute COVID-19 Syndrome, Humans, Child, Fatigue, Original Investigation, Aged, SARS-CoV-2, Mood Disorders, COVID-19, Bayes Theorem, Syndrome, General Medicine, Middle Aged, Child, Preschool, Female, Cognition Disorders, Respiratory Insufficiency
Abstract

ImportanceSome individuals experience persistent symptoms after initial symptomatic SARS-CoV-2 infection (often referred to as Long COVID).ObjectiveTo estimate the proportion of males and females with COVID-19, younger or older than 20 years of age, who had Long COVID symptoms in 2020 and 2021 and their Long COVID symptom duration.Design, Setting, and ParticipantsBayesian meta-regression and pooling of 54 studies and 2 medical record databases with data for 1.2 million individuals (from 22 countries) who had symptomatic SARS-CoV-2 infection. Of the 54 studies, 44 were published and 10 were collaborating cohorts (conducted in Austria, the Faroe Islands, Germany, Iran, Italy, the Netherlands, Russia, Sweden, Switzerland, and the US). The participant data were derived from the 44 published studies (10 501 hospitalized individuals and 42 891 nonhospitalized individuals), the 10 collaborating cohort studies (10 526 and 1906), and the 2 US electronic medical record databases (250 928 and 846 046). Data collection spanned March 2020 to January 2022.ExposuresSymptomatic SARS-CoV-2 infection.Main Outcomes and MeasuresProportion of individuals with at least 1 of the 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after SARS-CoV-2 infection in 2020 and 2021, estimated separately for hospitalized and nonhospitalized individuals aged 20 years or older by sex and for both sexes of nonhospitalized individuals younger than 20 years of age.ResultsA total of 1.2 million individuals who had symptomatic SARS-CoV-2 infection were included (mean age, 4-66 years; males, 26%-88%). In the modeled estimates, 6.2% (95% uncertainty interval [UI], 2.4%-13.3%) of individuals who had symptomatic SARS-CoV-2 infection experienced at least 1 of the 3 Long COVID symptom clusters in 2020 and 2021, including 3.2% (95% UI, 0.6%-10.0%) for persistent fatigue with bodily pain or mood swings, 3.7% (95% UI, 0.9%-9.6%) for ongoing respiratory problems, and 2.2% (95% UI, 0.3%-7.6%) for cognitive problems after adjusting for health status before COVID-19, comprising an estimated 51.0% (95% UI, 16.9%-92.4%), 60.4% (95% UI, 18.9%-89.1%), and 35.4% (95% UI, 9.4%-75.1%), respectively, of Long COVID cases. The Long COVID symptom clusters were more common in women aged 20 years or older (10.6% [95% UI, 4.3%-22.2%]) 3 months after symptomatic SARS-CoV-2 infection than in men aged 20 years or older (5.4% [95% UI, 2.2%-11.7%]). Both sexes younger than 20 years of age were estimated to be affected in 2.8% (95% UI, 0.9%-7.0%) of symptomatic SARS-CoV-2 infections. The estimated mean Long COVID symptom cluster duration was 9.0 months (95% UI, 7.0-12.0 months) among hospitalized individuals and 4.0 months (95% UI, 3.6-4.6 months) among nonhospitalized individuals. Among individuals with Long COVID symptoms 3 months after symptomatic SARS-CoV-2 infection, an estimated 15.1% (95% UI, 10.3%-21.1%) continued to experience symptoms at 12 months.Conclusions and RelevanceThis study presents modeled estimates of the proportion of individuals with at least 1 of 3 self-reported Long COVID symptom clusters (persistent fatigue with bodily pain or mood swings; cognitive problems; or ongoing respiratory problems) 3 months after symptomatic SARS-CoV-2 infection.

Published
2022

13. A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021

Author

Wulf Hanson, Sarah, primary, Abbafati, Cristiana, additional, Aerts, Joachim G, additional, Al-Aly, Ziyad, additional, Ashbaugh, Charlie, additional, Ballouz, Tala, additional, Blyuss, Oleg, additional, Bobkova, Polina, additional, Bonsel, Gouke, additional, Borzakova, Svetlana, additional, Buonsenso, Danilo, additional, Butnaru, Denis, additional, Carter, Austin, additional, Chu, Helen, additional, De Rose, Cristina, additional, Diab, Mohamed Mustafa, additional, Ekbom, Emil, additional, El Tantawi, Maha, additional, Fomin, Victor, additional, Frithiof, Robert, additional, Gamirova, Aysylu, additional, Glybochko, Petr V, additional, Haagsma, Juanita A., additional, Javanmard, Shaghayegh Haghjooy, additional, Hamilton, Erin B, additional, Harris, Gabrielle, additional, Heijenbrok-Kal, Majanka H, additional, Helbok, Raimund, additional, Hellemons, Merel E, additional, Hillus, David, additional, Huijts, Susanne M, additional, Hultström, Michael, additional, Jassat, Waasila, additional, Kurth, Florian, additional, Larsson, Ing-Marie, additional, Lipcsey, Miklós, additional, Liu, Chelsea, additional, Loflin, Callan D, additional, Malinovschi, Andrei, additional, Mao, Wenhui, additional, Mazankova, Lyudmila, additional, McCulloch, Denise, additional, Menges, Dominik, additional, Mohammadifard, Noushin, additional, Munblit, Daniel, additional, Nekliudov, Nikita A, additional, Ogbuoji, Osondu, additional, Osmanov, Ismail M, additional, Peñalvo, José L., additional, Petersen, Maria Skaalum, additional, Puhan, Milo A, additional, Rahman, Mujibur, additional, Rass, Verena, additional, Reinig, Nickolas, additional, Ribbers, Gerard M, additional, Ricchiuto, Antonia, additional, Rubertsson, Sten, additional, Samitova, Elmira, additional, Sarrafzadegan, Nizal, additional, Shikhaleva, Anastasia, additional, Simpson, Kyle E, additional, Sinatti, Dario, additional, Soriano, Joan B, additional, Spiridonova, Ekaterina, additional, Steinbeis, Fridolin, additional, Svistunov, Andrey A, additional, Valentini, Piero, additional, van de Water, Brittney J, additional, van den Berg-Emons, Rita, additional, Wallin, Ewa, additional, Witzenrath, Martin, additional, Wu, Yifan, additional, Xu, Hanzhang, additional, Zoller, Thomas, additional, Adolph, Christopher, additional, Albright, James, additional, Amlag, Joanne O, additional, Aravkin, Aleksandr Y, additional, Bang-Jensen, Bree L, additional, Bisignano, Catherine, additional, Castellano, Rachel, additional, Castro, Emma, additional, Chakrabarti, Suman, additional, Collins, James K, additional, Dai, Xiaochen, additional, Daoud, Farah, additional, Dapper, Carolyn, additional, Deen, Amanda, additional, Duncan, Bruce B, additional, Erickson, Megan, additional, Ewald, Samuel B, additional, Ferrari, Alize J, additional, Flaxman, Abraham D., additional, Fullman, Nancy, additional, Gamkrelidze, Amiran, additional, Giles, John R, additional, Guo, Gaorui, additional, Hay, Simon I, additional, He, Jiawei, additional, Helak, Monika, additional, Hulland, Erin N, additional, Kereselidze, Maia, additional, Krohn, Kris J, additional, Lazzar-Atwood, Alice, additional, Lindstrom, Akiaja, additional, Lozano, Rafael, additional, Magistro, Beatrice, additional, Malta, Deborah Carvalho, additional, Månsson, Johan, additional, Mantilla Herrera, Ana M, additional, Mokdad, Ali H, additional, Monasta, Lorenzo, additional, Nomura, Shuhei, additional, Pasovic, Maja, additional, Pigott, David M, additional, Reiner, Robert C, additional, Reinke, Grace, additional, Ribeiro, Antonio Luiz P, additional, Santomauro, Damian Francesco, additional, Sholokhov, Aleksei, additional, Spurlock, Emma Elizabeth, additional, Walcott, Rebecca, additional, Walker, Ally, additional, Wiysonge, Charles Shey, additional, Zheng, Peng, additional, Bettger, Janet Prvu, additional, Murray, Christopher JL, additional, and Vos, Theo, additional

Published
2022
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14. Intensive care-treated COVID-19 patients' perception of their illness and remaining symptoms.

Author

Wallin, Ewa, Hultström, Michael, Lipcsey, Miklós, Frithiof, Robert, Rubertsson, Sten, Larsson, Ing-Marie, Wallin, Ewa, Hultström, Michael, Lipcsey, Miklós, Frithiof, Robert, Rubertsson, Sten, and Larsson, Ing-Marie

Abstract

BACKGROUND: The remaining symptoms in patients with coronavirus disease 2019 (COVID-19) treated in intensive care unit are limited described. Therefore, we assessed patient's perception of their COVID-19 disease, stay in intensive care, and remaining symptoms three to six months after intensive care. METHODS: Prospective cohort study was performed in one intensive care unit of a university hospital in Sweden during the first wave. A questionnaire with open-ended questions and closed-ended questions was used. Data were analyzed using qualitative and quantitative content analysis and descriptive statistics. RESULTS: Out of 123 patients treated for COVID-19, 64 answered the questionnaire 3-6 months after discharge from intensive care. Memories from illness and hospital stay revealed in three categories; awareness of the illness, losing anchor to reality and being cared for in a dynamic environment. Information was perceived as spare by 48% and they wanted the information to be more personal. The diary was perceived as personal and was received by 33% patients. The relationship with family was affected among 39% and 13% of the patients indicated that they had not resumed their daily life. A large amount, 84%, indicated that they had remaining symptoms from COVID-19. The dominated symptoms were impaired strength and energy both physically and mentally. CONCLUSION: Patients reported a variety of physical and mental symptoms, and revealed memories from the ICU, and specific awareness of other patients' health. It illustrates the need for screening patients for remaining symptoms after COVID-19 disease and ICU care and may affect resuming patients' daily life.

Published
2022
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15. A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021

Author

Wulf Hanson, Sarah, Abbafati, Cristiana, Aerts, Joachim G, Al-Aly, Ziyad, Ashbaugh, Charlie, Ballouz, Tala, Blyuss, Oleg, Bobkova, Polina, Bonsel, Gouke, Borzakova, Svetlana, Buonsenso, Danilo, Butnaru, Denis, Carter, Austin, Chu, Helen, De Rose, Cristina, Diab, Mohamed Mustafa, Ekbom, Emil, El Tantawi, Maha, Fomin, Victor, Frithiof, Robert, Gamirova, Aysylu, Glybochko, Petr V, Haagsma, Juanita A, Javanmard, Shaghayegh Haghjooy, Hamilton, Erin B, Harris, Gabrielle, Heijenbrok-Kal, Majanka H, Helbok, Raimund, Hellemons, Merel E, Hillus, David, Huijts, Susanne M, Hultström, Michael, Jassat, Waasila, Kurth, Florian, Larsson, Ing-Marie, Lipcsey, Miklós, Liu, Chelsea, Loflin, Callan D, Malinovschi, Andrei, Mao, Wenhui, Mazankova, Lyudmila, McCulloch, Denise, Menges, Dominik, Mohammadifard, Noushin, Munblit, Daniel, Nekliudov, Nikita A, Ogbuoji, Osondu, Osmanov, Ismail M, Peñalvo, José L, Petersen, Maria Skaalum, Puhan, Milo A, Rahman, Mujibur, Rass, Verena, Reinig, Nickolas, Ribbers, Gerard M, Ricchiuto, Antonia, Rubertsson, Sten, Samitova, Elmira, Sarrafzadegan, Nizal, Shikhaleva, Anastasia, Simpson, Kyle E, Sinatti, Dario, Soriano, Joan B, Spiridonova, Ekaterina, Steinbeis, Fridolin, Svistunov, Andrey A, Valentini, Piero, van de Water, Brittney J, van den Berg-Emons, Rita, Wallin, Ewa, Witzenrath, Martin, Wu, Yifan, Xu, Hanzhang, Zoller, Thomas, Adolph, Christopher, Albright, James, Amlag, Joanne O, Aravkin, Aleksandr Y, Bang-Jensen, Bree L, Bisignano, Catherine, Castellano, Rachel, Castro, Emma, Chakrabarti, Suman, Collins, James K, Dai, Xiaochen, Daoud, Farah, Dapper, Carolyn, Deen, Amanda, Duncan, Bruce B, Erickson, Megan, Ewald, Samuel B, Ferrari, Alize J, Flaxman, Abraham D, Fullman, Nancy, Gamkrelidze, Amiran, Giles, John R, Guo, Gaorui, Hay, Simon I, He, Jiawei, Helak, Monika, Hulland, Erin N, Kereselidze, Maia, Krohn, Kris J, Lazzar-Atwood, Alice, Lindstrom, Akiaja, Lozano, Rafael, Magistro, Beatrice, Malta, Deborah Carvalho, Månsson, Johan, Mantilla Herrera, Ana M, Mokdad, Ali H, Monasta, Lorenzo, Nomura, Shuhei, Pasovic, Maja, Pigott, David M, Reiner, Robert C, Reinke, Grace, Ribeiro, Antonio Luiz P, Santomauro, Damian Francesco, Sholokhov, Aleksei, Spurlock, Emma Elizabeth, Walcott, Rebecca, Walker, Ally, Wiysonge, Charles Shey, Zheng, Peng, Bettger, Janet Prvu, Murray, Christopher Jl, Vos, Theo, Wulf Hanson, Sarah, Abbafati, Cristiana, Aerts, Joachim G, Al-Aly, Ziyad, Ashbaugh, Charlie, Ballouz, Tala, Blyuss, Oleg, Bobkova, Polina, Bonsel, Gouke, Borzakova, Svetlana, Buonsenso, Danilo, Butnaru, Denis, Carter, Austin, Chu, Helen, De Rose, Cristina, Diab, Mohamed Mustafa, Ekbom, Emil, El Tantawi, Maha, Fomin, Victor, Frithiof, Robert, Gamirova, Aysylu, Glybochko, Petr V, Haagsma, Juanita A, Javanmard, Shaghayegh Haghjooy, Hamilton, Erin B, Harris, Gabrielle, Heijenbrok-Kal, Majanka H, Helbok, Raimund, Hellemons, Merel E, Hillus, David, Huijts, Susanne M, Hultström, Michael, Jassat, Waasila, Kurth, Florian, Larsson, Ing-Marie, Lipcsey, Miklós, Liu, Chelsea, Loflin, Callan D, Malinovschi, Andrei, Mao, Wenhui, Mazankova, Lyudmila, McCulloch, Denise, Menges, Dominik, Mohammadifard, Noushin, Munblit, Daniel, Nekliudov, Nikita A, Ogbuoji, Osondu, Osmanov, Ismail M, Peñalvo, José L, Petersen, Maria Skaalum, Puhan, Milo A, Rahman, Mujibur, Rass, Verena, Reinig, Nickolas, Ribbers, Gerard M, Ricchiuto, Antonia, Rubertsson, Sten, Samitova, Elmira, Sarrafzadegan, Nizal, Shikhaleva, Anastasia, Simpson, Kyle E, Sinatti, Dario, Soriano, Joan B, Spiridonova, Ekaterina, Steinbeis, Fridolin, Svistunov, Andrey A, Valentini, Piero, van de Water, Brittney J, van den Berg-Emons, Rita, Wallin, Ewa, Witzenrath, Martin, Wu, Yifan, Xu, Hanzhang, Zoller, Thomas, Adolph, Christopher, Albright, James, Amlag, Joanne O, Aravkin, Aleksandr Y, Bang-Jensen, Bree L, Bisignano, Catherine, Castellano, Rachel, Castro, Emma, Chakrabarti, Suman, Collins, James K, Dai, Xiaochen, Daoud, Farah, Dapper, Carolyn, Deen, Amanda, Duncan, Bruce B, Erickson, Megan, Ewald, Samuel B, Ferrari, Alize J, Flaxman, Abraham D, Fullman, Nancy, Gamkrelidze, Amiran, Giles, John R, Guo, Gaorui, Hay, Simon I, He, Jiawei, Helak, Monika, Hulland, Erin N, Kereselidze, Maia, Krohn, Kris J, Lazzar-Atwood, Alice, Lindstrom, Akiaja, Lozano, Rafael, Magistro, Beatrice, Malta, Deborah Carvalho, Månsson, Johan, Mantilla Herrera, Ana M, Mokdad, Ali H, Monasta, Lorenzo, Nomura, Shuhei, Pasovic, Maja, Pigott, David M, Reiner, Robert C, Reinke, Grace, Ribeiro, Antonio Luiz P, Santomauro, Damian Francesco, Sholokhov, Aleksei, Spurlock, Emma Elizabeth, Walcott, Rebecca, Walker, Ally, Wiysonge, Charles Shey, Zheng, Peng, Bettger, Janet Prvu, Murray, Christopher Jl, and Vos, Theo

Abstract

Importance: While much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID. Objective: To estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery. Design: We jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study. Results: Analyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8-312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38-7.

Published
2022
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16. Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors : A prospective cohort study

Author

Milton, Anna, Schandl, Anna, Larsson, Ing-Marie, Wallin, Ewa, Savilampi, Johanna, Meijers, Katarina, Joelsson-Alm, Eva, Bottai, Matteo, Sackey, Peter, Milton, Anna, Schandl, Anna, Larsson, Ing-Marie, Wallin, Ewa, Savilampi, Johanna, Meijers, Katarina, Joelsson-Alm, Eva, Bottai, Matteo, and Sackey, Peter

Abstract

Background Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients’ physical and psychological outcomes. Methods A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3 months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers’ mental HRQL. Results Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (±standard deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong negative correlation between caregiver burden and informal caregivers’ mental HRQL (rs −0.74, p < 0.001). Conclusion Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems.

Published
2022
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17. Additional file 1 of Dehydration is associated with production of organic osmolytes and predicts physical long-term symptoms after COVID-19: a multicenter cohort study

Author

Hultström, Michael, Lipcsey, Miklos, Morrison, Dave R., Nakanishi, Tomoko, Butler-Laporte, Guillaume, Chen, Yiheng, Yoshiji, Satoshi, Forgetta, Vincenzo, Farjoun, Yossi, Wallin, Ewa, Larsson, Ing-Marie, Larsson, Anders, Marton, Adriana, Titze, Jens Marc, Nihlén, Sandra, Richards, J. Brent, and Frithiof, Robert

Abstract

Additional file 1. Clinical endpoints in Pronmed and Biobanque Québécoise de la COVID-19 (BQC19) for outcomes of acute COVID-19 and Long COVID-19 clustered as physical or mental symptoms.

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2022
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18. Dehydration is Associated with Production of Organic Osmolytes and Predicts Physical Long-Term Symptoms after COVID-19: A Multicenter Cohort Study

Author

Hultström, Michael, primary, Lipcsey, Miklos, additional, Morrison, Dave R., additional, Nakanishi, Tomoko, additional, Butler-Laporte, Guillaume, additional, Chen, Yiheng, additional, Yoshiji, Satoshi, additional, Forgetta, Vincenzo, additional, Farjoun, Yossi, additional, Wallin, Ewa, additional, Larsson, Ing-Marie, additional, Larsson, Anders, additional, Marton, Adriana, additional, Titze, Jens, additional, Nihlén, Sandra, additional, Richards, J. Brent, additional, and Frithiof, Robert, additional

Published
2022
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19. Body mass index is associated with pulmonary gas and blood distribution mismatch in COVID-19 acute respiratory failure. A physiological study.

Author

Bjarnadóttir KJ, Perchiazzi G, Sidenbladh CL, Larina A, Wallin E, Larsson IM, Franzén S, Larsson AO, Sousa MLA, Segelsjö M, Hansen T, Frithiof R, Hultström M, Lipcsey M, and Pellegrini M

Abstract

Background: The effects of obesity on pulmonary gas and blood distribution in patients with acute respiratory failure remain unknown. Dual-energy computed tomography (DECT) is a X-ray-based method used to study regional distribution of gas and blood within the lung. We hypothesized that 1) regional gas/blood mismatch can be quantified by DECT; 2) obesity influences the global and regional distribution of pulmonary gas and blood; 3) regardless of ventilation modality (invasive vs. non-invasive ventilation), patients' body mass index (BMI) has an impact on pulmonary gas/blood mismatch., Methods: This single-centre prospective observational study enrolled 118 hypoxic COVID-19 patients (92 male) in need of respiratory support and intensive care who underwent DECT. The cohort was divided into three groups according to BMI: 1. BMI<25 kg/m 2 (non-obese), 2. BMI = 25-40 kg/m 2 (overweight to obese), and 3. BMI>40 kg/m 2 (morbidly obese). Gravitational analysis of Hounsfield unit distribution of gas and blood was derived from DECT and used to calculate regional gas/blood mismatch. A sensitivity analysis was performed to investigate the influence of the chosen ventilatory modality and BMI on gas/blood mismatch and adjust for other possible confounders (i.e., age and sex)., Results: 1) Regional pulmonary distribution of gas and blood and their mismatch were quantified using DECT imaging. 2) The BMI>40 kg/m 2 group had less hyperinflation in the non-dependent regions and more lung collapse in the dependent regions compared to the other BMI groups. In morbidly obese patients, gas and blood were more evenly distributed; therefore, the mismatch was lower than in other patients (30% vs. 36%, p < 0.05). 3) An increase in BMI of 5 kg/m 2 was associated with a decrease in mismatch of 3.3% (CI: 3.67% to -2.93%, p < 0.05). Neither the ventilatory modality nor age and sex affected the gas/blood mismatch ( p > 0.05)., Conclusion: 1) In a hypoxic COVID-19 population needing intensive care, pulmonary gas/blood mismatch can be quantified at a global and regional level using DECT. 2) Obesity influences the global and regional distribution of gas and blood within the lung, and BMI>40 kg/m 2 improves pulmonary gas/blood mismatch. 3) This is true regardless of the ventilatory mode and other possible confounders, i.e., age and sex., Trial Registration: Clinicaltrials.gov, identifier NCT04316884, NCT04474249., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bjarnadóttir, Perchiazzi, Sidenbladh, Larina, Wallin, Larsson, Franzén, Larsson, Sousa, Segelsjö, Hansen, Frithiof, Hultström, Lipcsey and Pellegrini.)

Published
2024
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20. A global systematic analysis of the occurrence, severity, and recovery pattern of long COVID in 2020 and 2021.

Author

Hanson SW, Abbafati C, Aerts JG, Al-Aly Z, Ashbaugh C, Ballouz T, Blyuss O, Bobkova P, Bonsel G, Borzakova S, Buonsenso D, Butnaru D, Carter A, Chu H, De Rose C, Diab MM, Ekbom E, El Tantawi M, Fomin V, Frithiof R, Gamirova A, Glybochko PV, Haagsma JA, Javanmard SH, Hamilton EB, Harris G, Heijenbrok-Kal MH, Helbok R, Hellemons ME, Hillus D, Huijts SM, Hultström M, Jassat W, Kurth F, Larsson IM, Lipcsey M, Liu C, Loflin CD, Malinovschi A, Mao W, Mazankova L, McCulloch D, Menges D, Mohammadifard N, Munblit D, Nekliudov NA, Ogbuoji O, Osmanov IM, Peñalvo JL, Petersen MS, Puhan MA, Rahman M, Rass V, Reinig N, Ribbers GM, Ricchiuto A, Rubertsson S, Samitova E, Sarrafzadegan N, Shikhaleva A, Simpson KE, Sinatti D, Soriano JB, Spiridonova E, Steinbeis F, Svistunov AA, Valentini P, van de Water BJ, van den Berg-Emons R, Wallin E, Witzenrath M, Wu Y, Xu H, Zoller T, Adolph C, Albright J, Amlag JO, Aravkin AY, Bang-Jensen BL, Bisignano C, Castellano R, Castro E, Chakrabarti S, Collins JK, Dai X, Daoud F, Dapper C, Deen A, Duncan BB, Erickson M, Ewald SB, Ferrari AJ, Flaxman AD, Fullman N, Gamkrelidze A, Giles JR, Guo G, Hay SI, He J, Helak M, Hulland EN, Kereselidze M, Krohn KJ, Lazzar-Atwood A, Lindstrom A, Lozano R, Magistro B, Malta DC, Månsson J, Herrera AMM, Mokdad AH, Monasta L, Nomura S, Pasovic M, Pigott DM, Reiner RC Jr, Reinke G, Ribeiro ALP, Santomauro DF, Sholokhov A, Spurlock EE, Walcott R, Walker A, Wiysonge CS, Zheng P, Bettger JP, Murray CJ, and Vos T

Abstract

Importance: While much of the attention on the COVID-19 pandemic was directed at the daily counts of cases and those with serious disease overwhelming health services, increasingly, reports have appeared of people who experience debilitating symptoms after the initial infection. This is popularly known as long COVID., Objective: To estimate by country and territory of the number of patients affected by long COVID in 2020 and 2021, the severity of their symptoms and expected pattern of recovery., Design: We jointly analyzed ten ongoing cohort studies in ten countries for the occurrence of three major symptom clusters of long COVID among representative COVID cases. The defining symptoms of the three clusters (fatigue, cognitive problems, and shortness of breath) are explicitly mentioned in the WHO clinical case definition. For incidence of long COVID, we adopted the minimum duration after infection of three months from the WHO case definition. We pooled data from the contributing studies, two large medical record databases in the United States, and findings from 44 published studies using a Bayesian meta-regression tool. We separately estimated occurrence and pattern of recovery in patients with milder acute infections and those hospitalized. We estimated the incidence and prevalence of long COVID globally and by country in 2020 and 2021 as well as the severity-weighted prevalence using disability weights from the Global Burden of Disease study., Results: Analyses are based on detailed information for 1906 community infections and 10526 hospitalized patients from the ten collaborating cohorts, three of which included children. We added published data on 37262 community infections and 9540 hospitalized patients as well as ICD-coded medical record data concerning 1.3 million infections. Globally, in 2020 and 2021, 144.7 million (95% uncertainty interval [UI] 54.8-312.9) people suffered from any of the three symptom clusters of long COVID. This corresponds to 3.69% (1.38-7.96) of all infections. The fatigue, respiratory, and cognitive clusters occurred in 51.0% (16.9-92.4), 60.4% (18.9-89.1), and 35.4% (9.4-75.1) of long COVID cases, respectively. Those with milder acute COVID-19 cases had a quicker estimated recovery (median duration 3.99 months [IQR 3.84-4.20]) than those admitted for the acute infection (median duration 8.84 months [IQR 8.10-9.78]). At twelve months, 15.1% (10.3-21.1) continued to experience long COVID symptoms., Conclusions and Relevance: The occurrence of debilitating ongoing symptoms of COVID-19 is common. Knowing how many people are affected, and for how long, is important to plan for rehabilitative services and support to return to social activities, places of learning, and the workplace when symptoms start to wane., Key Points: Question: What are the extent and nature of the most common long COVID symptoms by country in 2020 and 2021? Findings: Globally, 144.7 million people experienced one or more of three symptom clusters (fatigue; cognitive problems; and ongoing respiratory problems) of long COVID three months after infection, in 2020 and 2021. Most cases arose from milder infections. At 12 months after infection, 15.1% of these cases had not yet recovered. Meaning: The substantial number of people with long COVID are in need of rehabilitative care and support to transition back into the workplace or education when symptoms start to wane.

Published
2022
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21. Intensive care-treated COVID-19 patients' perception of their illness and remaining symptoms.

Author

Wallin E, Hultström M, Lipcsey M, Frithiof R, Rubertsson S, and Larsson IM

Subjects
Critical Care, Humans, Perception, Prospective Studies, SARS-CoV-2, COVID-19
Abstract

Background: The remaining symptoms in patients with coronavirus disease 2019 (COVID-19) treated in intensive care unit are limited described. Therefore, we assessed patient's perception of their COVID-19 disease, stay in intensive care, and remaining symptoms three to six months after intensive care., Methods: Prospective cohort study was performed in one intensive care unit of a university hospital in Sweden during the first wave. A questionnaire with open-ended questions and closed-ended questions was used. Data were analyzed using qualitative and quantitative content analysis and descriptive statistics., Results: Out of 123 patients treated for COVID-19, 64 answered the questionnaire 3-6 months after discharge from intensive care. Memories from illness and hospital stay revealed in three categories; awareness of the illness, losing anchor to reality and being cared for in a dynamic environment. Information was perceived as spare by 48% and they wanted the information to be more personal. The diary was perceived as personal and was received by 33% patients. The relationship with family was affected among 39% and 13% of the patients indicated that they had not resumed their daily life. A large amount, 84%, indicated that they had remaining symptoms from COVID-19. The dominated symptoms were impaired strength and energy both physically and mentally., Conclusion: Patients reported a variety of physical and mental symptoms, and revealed memories from the ICU, and specific awareness of other patients' health. It illustrates the need for screening patients for remaining symptoms after COVID-19 disease and ICU care and may affect resuming patients' daily life., (© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Published
2022
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22. Caregiver burden and emotional wellbeing in informal caregivers to ICU survivors-A prospective cohort study.

Author

Milton A, Schandl A, Larsson IM, Wallin E, Savilampi J, Meijers K, Joelsson-Alm E, Bottai M, and Sackey P

Subjects
Adult, Caregiver Burden, Cohort Studies, Depression, Humans, Intensive Care Units, Prospective Studies, Survivors, Caregivers, Quality of Life
Abstract

Background: Informal caregivers to intensive care unit (ICU) survivors may develop post-intensive care syndrome family (PICS-F), including depression, anxiety and post-traumatic stress (PTS). Our primary aim was to investigate associations between caregiver burden in informal caregivers cohabiting with ICU survivors and patients' physical and psychological outcomes., Methods: A prospective, multicentre cohort study in four ICUs in Sweden. Adults cohabiting with ICU patients included in a previous study were eligible for inclusion. Three months post-ICU, informal caregivers received questionnaires assessing caregiver burden, health-related quality of life (HRQL) and symptoms of depression, anxiety and PTS. In parallel, patients reported their three-month physical and psychological status via validated questionnaires. The primary outcome of this study was to compare caregiver burden in informal caregivers to patients with and without adverse physical and psychological outcomes 3 months post-ICU. Secondary outcomes were correlations between caregiver burden and informal caregivers' mental HRQL., Results: Among 62 included informal caregivers, 55 (89%) responded to the follow-up questionnaires. Caregiver burden was higher among informal caregivers to patients with an adverse outcome, compared to informal caregivers to patients without an adverse outcome, caregiver burden scale score mean (±standard deviation) 52 (11) and 41 (13) respectively (p = 0.003). There was strong negative correlation between caregiver burden and informal caregivers' mental HRQL (r s -0.74, p < 0.001)., Conclusion: Informal caregivers to ICU survivors with adverse physical or psychological outcome experience a higher caregiver burden. A higher caregiver burden correlates with worse caregiver mental HRQL. ICU follow-up programs should consider screening and follow-up of informal caregivers for mental health problems., (© 2021 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.)

Published
2022
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