Long-term evaluation of patients with COVID-19 pneumonia followed in the intensive care unit with acute respiratory distress syndrome

Long-Term Evaluation of Patients with COVID-19 Pneumonia Followed in the Intensive Care Unit with Acute Respiratory Distress Syndrome Aim: The COVID-19 pandemic has strained global healthcare systems not only with its acute infectious phase but also due to its long-term complications. In particular, patients who developed acute respiratory distress syndrome (ARDS) and required intensive care have been reported to experience persistent physical, respiratory, neurocognitive, and psychological effects long after recovery. This study aimed to evaluate symptoms of long-term followed up, quality of life, pulmonary functions, and radiological sequelae in patients followed up COVID-19-related ARDS in our intensive care unit and to investigate the relationship between acute-phase parameters and the development of sequelae. Methods: This prospective study included 52 patients who were treated in the intensive care unit of Cukurova University Faculty of Medicine Hospital due to COVID-19 pneumonia-related ARDS and subsequently discharged between March 2020 and May 2022. Structured face-to-face interviews were conducted to assess post-COVID symptoms. Pulmonary function tests (PFTs and DLCO), the Six-Minute Walk Test (6MWT), high-resolution thoracic CT scans, and the SF-36 quality of life questionnaire were applied. Findings were analyzed in correlation with laboratory data from the acute phase. Results: The mean follow up period was 48,15,7 months and Persistent symptoms such as dyspnea (67.3%), fatigue (55.8%), and memory impairment (28.8%) were detected. DLCO reduction was the most common respiratory abnormality (48.6%). CT scans revealed fibrotic sequelae in 67.4% of patients. Significant impairments were observed in physical functioning, vitality, and emotional role domains of the SF-36. Lymphocyte levels of hospitalization ≤0.5 showed a significantly higher prevalence of radiological sequelae (specificity: 80% , positive predictive value: 88.5%). Conclusion: Patients who experienced COVID-19-related ARDS exhibit persistent multidimensional functional and structural impairments in the long term. DLCO reduction and fibrotic changes are the most prominent objective findings, and low lymphocyte count may serve as a significant biomarker for sequela development. Effective follow-up and the implementation of multidisciplinary rehabilitation strategies are essential for managing post-COVID syndrome. Keywords: COVID-19, ARDS, post-COVID syndrome, pulmonary function test, DLCO, quality of life, lymphopenia, fibrotic sequelae