This study assesses the multidimensional health status of COVID-19 survivors one-year post-infection using validated subjective and objective measures.
Rationale: Within the Netherlands, more than 1 million people have been infected with SARS-CoV-2, also known as COVID-19. Although the mortality rate is considerable, the vast majority of COVID-19 patients survive the infection. Preliminary findings show that a majority of COVID-19 survivors still experience health problems 3 months after the infection, including reduced lung diffusion capacity, low exercise capacity, muscle weakness, mental problems and reduced cognitive function resulting in a generally poor health status. Whether these health consequences persist on the long-term is unknown. Objective: To assess the multidimensional health status of COVID-19 survivors one-year post-infection using validated subjective and objective measures. Study design: A multicenter prospective observational study performed within the MUMC+ and VieCuri Medical Center. Study population: 200 COVID-19 survivors of the MUMC+, VieCuri Medical Center or Zuyderland Medical Center, both hospitalized (ICU and non-ICU admitted) as well as non-hospitalized patients. Main study parameters/endpoints: Outcome parameters include objectively and subjectively measured multidimensional health outcomes including physiological and metabolic health, physical capability, cognitive function, psychosocial well-being, social well-being, patient reported outcomes as well as potential determinants of these multidimensional health outcomes (e.g. treatment during/after SARS-CoV-2 infection, vaccination, comorbidities, medication use etc.). Outcomes will be measured during a one-day study visit. Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Subjects will benefit from participating within this study, because their general health will be evaluated in detail and from a multidimensional perspective. Furthermore, subjects will be informed on their multidimensional health outcomes and will receive a lifestyle advice tailored to their health status. Risks and inconveniences are limited to the time investment associated with the completion of the questionnaires and the study visit. During the study visit various non-invasive measurements as well as minor invasive blood sampling will be performed.
Study Type
OBSERVATIONAL
Enrollment
140
Zuyderland Medical Center
Heerlen, Netherlands
Maastricht University Medical Center
Maastricht, Netherlands
VieCuri Medical Center
Venlo, Netherlands
Lung function measured with spirometry
Pre- and post-bronchodilator spirometry will be performed to determine forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1).
Time frame: 1 year post-infection
Diffusion capacity measured with the single breath method
To determine diffusion capacity for carbon monoxide
Time frame: 1 year post-infection
(Persistent) lung damage
To determine lung damage a chest CT-scan will be obtained. To evaluate whether lung damage is persistent, scans will be compared to scans obtained during COVID-19 screening or COVID-19 after care.
Time frame: 1 year post-infection
Bone mineral density by dual-energy X-ray (DEXA)-scan
Total bone mineral density (BMD) as well as BMD of the lumbar spine and total hip-neck will be determined using a DEXA-scan.
Time frame: 1 year post-infection
Lean mass by dual-energy X-ray (DEXA)-scan
Total lean mass will be determined using a DEXA-scan.
Time frame: 1 year post-infection
Fat free mass by dual-energy X-ray (DEXA)-scan
Total fat free mass will be measured using a DEXA-scan.
Time frame: 1 year post-infection
Fat mass by dual-energy X-ray (DEXA)-scan
Total fat mass and fat percentage as well as visceral fat mass will be measured using a DEXA-scan.
Time frame: 1 year post-infection
Vertebral fracture assessment by dual-energy X-ray (DEXA-scan)
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Vertebral fracture assessment will be determined using a DEXA-scan.
Time frame: 1 year post-infection
Muscle cross sectional area on chest CT-scan
Muscle cross sectional area will be determined based on pre-established Hounsfield Units on the chest CT-scan.
Time frame: 1 year post-infection
Adipose tissue cross sectional area on chest CT-scan
Muscle cross sectional area will be determined based on pre-established Hounsfield Units on the chest CT-scan.
Time frame: 1 year post-infection
Weight will be measured on a weighing scale
Weight will be measured on a weighing scale.
Time frame: 1 year post-infection
Height will be measured using a stadiometer
Height will be measured using a stadiometer.
Time frame: 1 year post-infection
Body mass index (BMI) will be calculated from the weight and height
Weight and height will be combined to report BMI in (kg/m\^2)
Time frame: 1 year post-infection
Fasted resting energy expenditure by indirect calorimetry (ventilated hood)
VO2 and VCO2 will be measured to determine energy expenditure.
Time frame: 1 year post-infection
Resting blood pressure
Resting diastolic and systolic blood pressure will be measured as part of the cardiometabolic profile to determine the prevalence of the metabolic syndrome.
Time frame: 1 year post-infection
Waist circumference
Waist circumference will be measured as part of the cardiometabolic profile to determine the prevalence of the metabolic syndrome.
Time frame: 1 year post-infection
Fasting glucose levels
Fasting glucose levels will be determined in sampled blood as part of the cardiometabolic profile to determine the prevalence of the metabolic syndrome.
Time frame: 1 year post-infection
Fasted lipid profile
Fasted high-density, low-density and total lipoprotein levels (HDL and LDL) as well as triglycerides will be measured as part of the cardiometabolic profile to determine the prevalence of the metabolic syndrome.
Time frame: 1 year post-infection
Six minute walking test to determine exercise capacity
Six minute walking distance will be determined.
Time frame: 1 year post-infection
Peak work rate by cardiopulmonary cycling exercise test (CPET)
Maximal work rate (W) will be determined during the CPET
Time frame: 1 year post-infection
Peak O2-consumption and CO2-production by cardiopulmonary cycling exercise test (CPET)
Maximal O2 consumption and CO2 production will be determined during the CPET.
Time frame: 1 year post-infection
Maximal heart rate during cardiopulmonary cycling exercise test (CPET)
Maximal heart will be measured during the CPET.
Time frame: 1 year post-infection
Respiratory muscle strength by mouth pressure
Inspiratory and expiratory mouth pressure will be measured.
Time frame: 1 year post-infection
Upper extremity muscle strength by measuring handgrip strength
A hydraulic grip strength dynamometer will be used to measure the maximal handgrip strength.
Time frame: 1 year post-infection
Lower extremity muscle strength by measuring isometric muscle strength
Maximal isometric upper leg muscle strength will be measured of the quadriceps muscle using a Biodex dynamometer.
Time frame: 1 year post-infection
Mobility using the short physical performance battery (SPPB)
The SPPB consists of three types of physical maneuvers: the balance test, the gait speed test and the chair stand test leading to a score of 0-12. Lower scores indicate less mobility.
Time frame: 1 year post-infection
Physical activity level by accelerometry
An accelerometer will be worn for 7 days to determine physical activity level.
Time frame: 1 year post-infection
Cognitive function by Montreal Cognitive Assessment (MOCA)
The MOCA will lead to a total score of 0-30, in which lower scores indicate less cognitive function.
Time frame: 1 year post-infection
Cognitive function using the cognitive failure questionnaire (CFQ)
The CFQ will lead to a total score of 0-100. A higher total score indicates more subjective cognitive failure. Additionally, four subscales can be identified, related to distraction, distraction in social situations, names and words and orientation.
Time frame: 1 year post-infection
Dietary intake by a food diary
A 3-day food diary will be used to investigate the dietary intake.
Time frame: 1 year post-infection
Smell by the Sniffing Sticks treshold test
The average of the last four reversal points is used as final threshold score.
Time frame: 1 year post-infection
Taste using the taste strips 'filter paper disc method' test
A maximum score of 16 correct taste detections can be retrieved indication good taste function.
Time frame: 1 year post-infection
Taste and smell function using the taste and smell function questionnaire
The questionnaire will retrieve a maximal score of 0-52 and 0-44 for taste and smell, respectively, in which higher scores indicate problems with taste and smell function.
Time frame: 1 year post-infection
The hospital anxiety and depression scale (HADS) to determine anxiety and depression levels
The HADS will retrieve a total score of 0-21 in which lower levels indicate higher levels of anxiety or depression.
Time frame: 1 year post-infection
The Perceived stress scale (PSS) to determine stress levels
The PSS will retrieve a total score of 0-40 in which lower scores indicate higher stress levels.
Time frame: 1 year post-infection
Perceived social support using the multidimensional scale of perceived social support (MSPSS)
A total score of 12-84 can be retrieved in which lower scores indicate lower levels of social support.
Time frame: 1 year post-infection
Loneliness using the loneliness scale (LS)
The LS will retrieve a total score of 0-11 in which higher scores indicate strong loneliness.
Time frame: 1 year post-infection
Subjective multidimensional health status by euroqol-5 dimensions
The EQ-5D consists of 5 domains (mobility, self-care, usual activity, pain/discomfort, anxiety/depression) and a visual analogue scale.
Time frame: 1 year post-infection
Dyspnea using the modified medical research council (mMRC)
The mMRC will retrieve a total score of 0-5 in which higher levels indicate more dyspnea.
Time frame: 1 year post-infection
Fatigue using the Checklist Individual Strength (CIS)
The CIS will retrieve a total score of 20-140 in which higher scores indicate more fatigue.
Time frame: 1 year post-infection
Sleep quality using the Pittsburgh Sleep Quality Index (PSQI)
The total PSQI score will vary between 0-21 in which higher scores indicate poor sleep quality.
Time frame: 1 year post-infection
General pain using the Visual Analogue Scale (VAS)
A total score of 0-100 will be retrieved in which higher scores indicate more pain.
Time frame: 1 year post-infection
Medical history
Retrieved from medical records and self-report
Time frame: 1 year post-infection
Treatments/therapies after SARS-CoV-2 infection
Retrieved from medical records and self-report
Time frame: 1 year post-infection
Vaccination for COVID-19
Retrieved from medical records and self-report
Time frame: 1 year post-infection
Re-infection with COVID-19
Retrieved from medical records and self-report
Time frame: 1 year post-infection
Medication use
Retrieved from medical records and self-report
Time frame: 1 year post-infection