Association of Frailty, Organ Support, and Long-Term Survival in Critically Ill Patients With COVID-19

Taniguchi, Leandro Utino; Avelino‐Silva, Thiago Junqueira; Dias, Murilo Bacchini; Jacob‐Filho, Wilson; Aliberti, Márlon Juliano Romero

doi:10.1097/cce.0000000000000712

Cited by 11 publications

(11 citation statements)

References 29 publications

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“…Our longitudinal prospective cohort from Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo has been described in previous publications, including the 3-month outcomes ( 7 , 8 ). Briefly, we consolidated information from two studies (the CO-FRAIL [COVID-19 and Frailty] study [ 9 ] and the EPICCoV [Epidemiology of Critical COVID-19] study [ 10 ]) to generate a cohort of patients aged ⩾50 years who had confirmed COVID-19 and were consecutively hospitalized between March 30 and July 7, 2020.…”

Section: Methodsmentioning

confidence: 99%

Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors

et al. 2023

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Rationale Recent reports suggest that patients with severe coronavirus disease (COVID-19) often experience long-term consequences of the infection. However, studies on intensive care unit (ICU) survivors are underrepresented. Objectives We aimed to explore 12-month clinical outcomes after critical COVID-19, describing the longitudinal progress of disabilities, frailty status, frequency of cognitive impairment, and clinical events (rehospitalization, institutionalization, and falls). Methods We performed a prospective cohort study of survivors of COVID-19 ICU admissions in Sao Paulo, Brazil. We assessed patients every 3 months for 1 year after hospital discharge and obtained information on 15 activities of daily living (basic, instrumental, and mobility activities), frailty, cognition, and clinical events. Results We included 428 patients (mean age of 64 yr, 61% required invasive mechanical ventilation during ICU stay). The number of disabilities peaked at 3 months compared with the pre–COVID-19 period (mean difference, 2.46; 99% confidence interval, 1.94–2.99) and then decreased at 12 months (mean difference, 0.67; 99% confidence interval, 0.28–1.07). At 12-month follow-up, 12% of patients were frail, but half of them presented frailty only after COVID-19. The prevalence of cognitive symptoms was 17% at 3 months and progressively decreased to 12.1% ( P = 0.012 for trend) at the end of 1 year. Clinical events occurred in all assessments. Conclusions Although a higher burden of disabilities and cognitive symptoms occurred 3 months after hospital discharge of critical COVID-19 survivors, a significant improvement occurred during the 1-year follow-up. However, one-third of the patients remained in worse conditions than their pre–COVID-19 status.

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Section: Methodsmentioning

confidence: 99%

Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors

et al. 2023

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“…Mildly frail patients (CFS 4–5) had increased risk of severe outcomes compared to fit individuals (CFS 1–3) in several (but not all) clinical studies [ 573 , 576 ]; severe frailty (CFS 6–9) showed a correlation with severe disease consistently and with a greater effect size [ 572 , 573 , 578 ]. COVID-19 mortality is gradually increasing with the CFS even when controlling for age and sex [ 579 , 580 ]. A similar relationship has been observed with all-cause mortality and different frailty measures as well [ 581 , 582 , 583 ].…”

Section: Host Factorsmentioning

confidence: 99%

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

Zsichla

Müller

2023

Viruses

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The clinical course and outcome of COVID-19 are highly variable, ranging from asymptomatic infections to severe disease and death. Understanding the risk factors of severe COVID-19 is relevant both in the clinical setting and at the epidemiological level. Here, we provide an overview of host, viral and environmental factors that have been shown or (in some cases) hypothesized to be associated with severe clinical outcomes. The factors considered in detail include the age and frailty, genetic polymorphisms, biological sex (and pregnancy), co- and superinfections, non-communicable comorbidities, immunological history, microbiota, and lifestyle of the patient; viral genetic variation and infecting dose; socioeconomic factors; and air pollution. For each category, we compile (sometimes conflicting) evidence for the association of the factor with COVID-19 outcomes (including the strength of the effect) and outline possible action mechanisms. We also discuss the complex interactions between the various risk factors.

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“…[96][97][98] While COVID-19 adverse effects are greater in older people, previous work highlighted that age itself should not be used to define the prognosis of this disease. [99][100][101][102][103] On the contrary, COVID-19 prognosis depends primarily on the interactions between acute illness severity with previous functional status, determined by vulnerability measures (eg, frailty, functional disability, cognitive impairment). 104 As the pandemic advances, awareness has shifted to the long-term consequences of COVID-19.…”

Section: Barriers and Future Perspectivesmentioning

confidence: 99%

Delivering patient-centered care: outcomes of comprehensive geriatric assessment across healthcare settings

Roma

Garção²,

Covinsky³

et al. 2022

Geriatr Gerontol Aging

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Comprehensive geriatric assessment (CGA) is a systematic multidimensional and interdisciplinary evaluation that enables clinicians to recognize age-related impairments and develop a coordinated treatment plan and follow-up suited to the patient's needs. Considering the growing number of older persons requiring care in health systems everywhere and the importance of shifting from a disease-specific care model to a more comprehensive care model, we aimed to present the benefits of CGA for older people in different healthcare settings using a narrative review. This patient-centered model of care has been associated with lower hospital (re)admission, maintenance of function, improved quality of life, less caregiver burden, and higher patient satisfaction with the care provided across different healthcare settings. In some contexts — for example, hospitalized older people —, CGA has already been established as the standard model of care as it was consistently related to reduced mortality. Consistent findings from specific contexts (eg, oncology, orthopaedics) also show the importance of CGA in aiding clinicians make better decisions for older patients. It is noteworthy that further evidence from cost-effectiveness studies is still warranted, particularly in community settings. Another encouraging topic for future research is the role of technology in disseminating CGA-based models of care.

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Association of Frailty, Organ Support, and Long-Term Survival in Critically Ill Patients With COVID-19

Cited by 11 publications

References 29 publications

Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors

Twelve Months and Counting: Following Clinical Outcomes in Critical COVID-19 Survivors

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

Delivering patient-centered care: outcomes of comprehensive geriatric assessment across healthcare settings

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