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

Abstract

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. Graphical Abstract

Serial SOFA‐score trends in ICU‐admitted COVID‐19 patients as predictor of 28‐day mortality: A prospective cohort study

“…In fact, some large prospective cohorts have discussed that such data, that is, frailty, daily‐life activities, could plausibly influence mortality rate of COVID‐19, particularly in elderly patients. 34 , 35 Since the data of our study lacks such information regarding activity of daily life or frailty, we could have overlooked its potential role in impacting the 28‐day mortality in patients; so future studies are needed to shed light on the matter.…”

Long-Term Impairment in Activities of Daily Living Following COVID-19 in Residents of Long-Term Care Facilities

“…Three months after recovery from the disease, hospitalization, age ≥75 years, and cardiovascular comorbidity were independent predictors of worsening of the BI. COVID-19-related hospitalization can produce a long-term worsening in the frailty of survivors, especially in patients who had reduced quality of life before infection [ 39 , 40 ]. However, most older adults admitted to the intensive care unit due to COVID-19 had no ADL restriction before hospitalization and lived without severe frailty [ 40 ].…”

Prolonged intensive care: muscular functional, and nutritional insights from the COVID-19 pandemic

“…The importance of determining the risk of frailty has increased during the past 5 years because of its effects on the outcomes of critically ill patients and their families. Tools such as the frailty scale, clinical frailty scale, hospital frailty scale (>5 points), and Katz index (<6 points) should guide preventive healthcare decisions, such as the early start of rehabilitation programs, integration of geriatric services, and palliative and end-of-life care [ 38 , 39 ]. Currently validated scales for critically ill patients provide valuable information about not only muscle strength but also functional status, such as the ability to sit, stand, or walk.…”