**Background:** Coronavirus disease 2019 (COVID-19) ranges from asymptomatic infection to critical illness requiring intensive care unit (ICU) treatment. While in-hospital mortality is well-characterized, long-term sequelae including fatigue, muscle weakness, cognitive dysfunction, and posttraumatic stress disorder can persist as post-COVID-19 syndrome and impact health-related quality of life (HRQoL). Prior systematic reviews with limited follow-up up to 6 months concluded that post-COVID-19 HRQoL remained poor. The current study aimed to determine HRQoL after COVID-19 hospitalization using longitudinal assessment in both non-ICU and ICU patients, employing instruments covering overall HRQoL as well as depression, anxiety, stress, and fatigue.
**Methods:** This was a single-center longitudinal study at the University Hospital of Würzburg, Germany. Adult patients (≥18 years) hospitalized with RT-PCR-confirmed COVID-19 between March and December 2020 were eligible. None were vaccinated during acute illness. Patients were categorized by need for ICU or non-ICU treatment. Baseline demographics, comorbidities, and clinical characteristics were recorded. Telephone interviews were conducted at 3 and 12 months after discharge using scripted protocols by trained personnel. Instruments included: EQ-5D-5L (general HRQoL, with German value set), PHQ-9 (depression, cutoff ≥10), GAD-7 (generalized anxiety disorder, cutoff ≥10), FACIT fatigue scale (severe fatigue <30), PSS-10 (perceived stress: low 0–13, moderate 14–26, high 27–40), and PTSS-10 (posttraumatic stress: score ≥18 = case, ≥12 = need for psychological help). FACIT, PSS-10, and PTSS-10 were collected only at 12 months. Functional status items included return to work, living situation, and clinical frailty. Statistical analysis used two-tailed Mann–Whitney U test, Pearson’s Chi-squared test, and Spearman correlation; p ≤ 0.05 was considered significant.
**Key Results:** Of 189 eligible patients, consent was obtainable in 85 (45 ICU, 40 non-ICU). 3-month follow-up was available in 35 non-ICU and 27 ICU patients; 12-month follow-up in 38 non-ICU and 30 ICU patients. ICU mortality was 22% (10 patients); no additional deaths occurred during follow-up. Median age was 63 (54–73) in non-ICU and 61 (52–68) in ICU patients. BMI was significantly higher in ICU (29 kg/m²) vs. non-ICU (26 kg/m²) (p = 0.0007). 89% of ICU patients were mechanically ventilated; 44% required ECMO; 36% required renal replacement therapy. The mean EQ-5D-5L index differed between non-ICU (0.78 ± 0.33 at 3 months; 0.84 ± 0.23 at 12 months) and ICU patients (0.71 ± 0.27; 0.74 ± 0.2), with a significant difference at 12 months (p = 0.0013). Mobility significantly differed between groups at 12 months (p = 0.0155): only one-third of ICU patients reported no mobility problems vs. 56% of non-ICU patients. Usual activities were significantly impaired in ICU patients at both 3 months (p = 0.0334) and 12 months (p = 0.0021). After 12 months, 58% of non-ICU patients resumed usual activities vs. only 25% of ICU patients reporting no problems. 87% of non-ICU and 80% of ICU patients lived independently at home. Return to work was 47% (non-ICU) and 37% (ICU); 37% of ICU patients cited disability as reason for not returning. PHQ-9 scores significantly differed between groups at 12 months (p = 0.0003), but using cutoff ≥10, depression rates were 18% (non-ICU) and 20% (ICU) (not significant). GAD-7 ≥10 was present in 0% of non-ICU vs. 13% of ICU patients at 12 months (p = 0.0203). FACIT fatigue scores <30 were found in 21% (non-ICU) and 30% (ICU) (p = 0.3975). PSS-10 showed only 24% of non-ICU and 3% of ICU patients had low perceived stress (p = 0.0186); high perceived stress was present in 18% (non-ICU) and 30% (ICU). PTSS-10 ≥18 (indicating PTSD) was found in 5% (non-ICU) and 10% (ICU) (p = 0.4574); 16% of non-ICU and 23% of ICU had PTSS-10 ≥12.
**Clinical Implications:** HRQoL in COVID-19 ICU survivors was significantly reduced at both 3 and 12 months compared to non-ICU patients, with less improvement over time. The EQ-5D-5L index scores in ICU patients (0.74 at 12 months) were comparable to those reported in mild heart failure (NYHA I/II) or survivors of non-COVID ARDS. Mental health issues were prominent: depression affected approximately one-fifth of both groups, fatigue affected one-third of ICU patients, and nearly all ICU survivors experienced moderate-to-high perceived stress at one year. PTSD and anxiety were less common. The authors emphasize the need to educate patients and primary care providers about monitoring mental well-being post-COVID-19. Limitations include the single-center design, high proportion of ECMO patients (44%), potential selection bias (55% of eligible patients did not consent), lack of adjustment for confounders, and absence of pulmonary function or 6-minute walk test data.