The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19.

Bruno, Raphael Romano; Wernly, Bernhard; Flaatten, Hans; Fjølner, Jesper; Artigas, Antonio; Baldia, Philipp Heinrich; Binneboessel, Stephan; Bollen Pinto, Bernardo; Schefold, Joerg C; Wolff, Georg; Kelm, Malte; Beil, Michael; Sviri, Sigal; van Heerden, Peter Vernon; Szczeklik, Wojciech; Elhadi, Muhammed; Joannidis, Michael; Oeyen, Sandra; Kondili, Eumorfia; Marsh, Brian; ... (2022). The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19. Annals of intensive care, 12(1), p. 26. Springer 10.1186/s13613-022-00996-9

Preview

Text s13613-022-00996-9.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (2MB) | Preview

PURPOSE

Critically ill old intensive care unit (ICU) patients suffering from Sars-CoV-2 disease (COVID-19) are at increased risk for adverse outcomes. This post hoc analysis investigates the association of the Activities of Daily Living (ADL) with the outcome in this vulnerable patient group.

METHODS

The COVIP study is a prospective international observational study that recruited ICU patients ≥ 70 years admitted with COVID-19 (NCT04321265). Several parameters including ADL (ADL; 0 = disability, 6 = no disability), Clinical Frailty Scale (CFS), SOFA score, intensive care treatment, ICU- and 3-month survival were recorded. A mixed-effects Weibull proportional hazard regression analyses for 3-month mortality adjusted for multiple confounders.

RESULTS

This pre-specified analysis included 2359 patients with a documented ADL and CFS. Most patients evidenced independence in their daily living before hospital admission (80% with ADL = 6). Patients with no frailty and no disability showed the lowest, patients with frailty (CFS ≥ 5) and disability (ADL < 6) the highest 3-month mortality (52 vs. 78%, p < 0.001). ADL was independently associated with 3-month mortality (ADL as a continuous variable: aHR 0.88 (95% CI 0.82-0.94, p < 0.001). Being "disable" resulted in a significant increased risk for 3-month mortality (aHR 1.53 (95% CI 1.19-1.97, p 0.001) even after adjustment for multiple confounders.

CONCLUSION

Baseline Activities of Daily Living (ADL) on admission provides additional information for outcome prediction, although most critically ill old intensive care patients suffering from COVID-19 had no restriction in their ADL prior to ICU admission. Combining frailty and disability identifies a subgroup with particularly high mortality.

TRIAL REGISTRATION NUMBER

NCT04321265.

Interest & Impact

Downloads

35 since deposited on 21 Mar 2022
19 in the past 12 months

Citations

5 Citations in Web of Science ®
6 Citations in Scopus

Search

in Google Scholar™

Services

Actions (login required)

Edit item

Actions (login required)

Edit item