COVID-19: Symptoms at 6 Months / IL-6 Inhibitors / Delirium Risk Factors

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Take a look at some of the latest COVID-19 news:

Symptoms at 6 months: Three quarters of adults hospitalized with COVID-19 report at least one persistent symptom at 6 months, according to a study in The Lancet. Roughly 1700 COVID-19 patients (median age, 57) who'd been discharged from a Wuhan hospital were evaluated at a median of 6 months after symptom onset. Overall, 63% reported muscle weakness or fatigue, 26% had sleep difficulties, and 23% had anxiety or depression. Patients with the most severe illness during hospitalization were more likely to have symptoms 6 months later. Among those who underwent lung function tests at follow-up, prevalence of lung diffusion impairment ranged from 22% among those with the least severe illness to 56% among those with the most severe. Of note, 13% of patients without acute kidney injury who had normal eGFR during their admission had decreased eGFR at 6 months.

IL-6 inhibitors: U.K. health officials now say clinicians should consider using the interleukin-6 (IL-6) inhibitor tocilizumab, with sarilumab as an alternative, for critically ill COVID-19 patients. The recommendation came a day after findings from a randomized trial were posted on the preprint server medRxiv. In that trial, roughly 800 ICU patients were assigned to receive tocilizumab, sarilumab, or standard care within 24 hours of ICU admission. The in-hospital mortality rate was 28% with tocilizumab, 22% with sarilumab, and 36% with standard care. U.K. officials note that 80% of trial participants also received corticosteroids; thus, the benefit from IL-6 inhibitors "is thought to be supplementary to those from corticosteroids." Prior findings on IL-6 inhibitors for COVID-19 have been mixed, and the U.S. National Institutes of Health currently recommends against their use outside of clinical trials.

Delirium risk factors: Over half of critically ill COVID-19 patients experience delirium, according to an analysis of some 2000 ICU patients across 14 countries. Delirium lasted for a median of 3 days (range, 2–6 days). In addition, 82% were comatose for a median of 10 days. Use of benzodiazepines during invasive mechanical ventilation — noted in 64% of patients — was independently associated with increased risk for delirium. Family or friend visitation (virtual or in-person) occurred on only 17% of days — and was associated with decreased risk for delirium. In The Lancet Respiratory Medicine, researchers write, "Strategies to modify these approaches might mitigate delirium and any associated sequelae."