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. 2022 Mar 18;12(1):26.
doi: 10.1186/s13613-022-00996-9.

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

Raphael Romano Bruno  1 , Bernhard Wernly  2   3 , Hans Flaatten  4 , Jesper Fjølner  5 , Antonio Artigas  6 , Philipp Heinrich Baldia  1 , Stephan Binneboessel  1 , Bernardo Bollen Pinto  7 , Joerg C Schefold  8 , Georg Wolff  1 , Malte Kelm  1 , Michael Beil  9 , Sigal Sviri  9 , Peter Vernon van Heerden  9 , Wojciech Szczeklik  10 , Muhammed Elhadi  11 , Michael Joannidis  12 , Sandra Oeyen  13 , Eumorfia Kondili  14 , Brian Marsh  15 , Jakob Wollborn  16 , Finn H Andersen  17   18 , Rui Moreno  19   20 , Susannah Leaver  21 , Ariane Boumendil  22 , Dylan W De Lange  23 , Bertrand Guidet  22   24 , Christian Jung  25 ; COVIP study group
Collaborators, Affiliations

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

Raphael Romano Bruno et al. Ann Intensive Care. .

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.

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Conflict of interest statement

The authors declare that they have no competing interests. JCS reports grants (full departmental disclosure) from Orion Pharma, Abbott Nutrition International, B. Braun Medical AG, CSEM AG, Edwards Lifesciences Services GmbH, Kenta Biotech Ltd, Maquet Critical Care AB, Omnicare Clinical Research AG, Nestle, Pierre Fabre Pharma AG, Pfizer, Bard Medica S.A., Abbott AG, Anandic Medical Systems, Pan Gas AG Healthcare, Bracco, Hamilton Medical AG, Fresenius Kabi, Getinge Group Maquet AG, Dräger AG, Teleflex Medical GmbH, Glaxo Smith Kline, Merck Sharp and Dohme AG, Eli Lilly and Company, Baxter, Astellas, Astra Zeneca, CSL Behring, Novartis, Covidien, Philips Medical, Phagenesis Ltd, Prolong Pharmaceuticals and Nycomed outside the submitted work. The money went into departmental funds. No personal financial gain applied.

Figures

Fig. 1
Fig. 1
Consort diagram
Fig. 2
Fig. 2
A Distribution of documented ADL on admission (6 = no disability; 0 = fully dependend). B Distribution of CFS (1 = no frailty; 9 = terminally frail)
Fig. 3
Fig. 3
Kaplan–Meier for patients with a disability (ADL < 6, red line) compared to patients without a disability (ADL 6, blue line) (3-month mortality, ± 95% CI). p < 0.001 log-rank test
Fig. 4
Fig. 4
ICU-, 30-day and 3-month mortality [%] for patients with neither frailty (CFS ≤ 5) nor disability (ADL 6), frailty or disability, or frailty and disability. **p < 0.001
Fig. 5
Fig. 5
Kaplan–Meier for patients without a disability and frailty (ADL 6 and CFS < 5, blue line) compared to patients with a disability or frailty (ADL < 6 or CFS ≥ 5), red line), and patients with disability and frailty (green line) (3-month mortality, ± 95% CI). p < 0.001 log-rank test
Fig. 6
Fig. 6
Kaplan–Meier for patients with a disability (ADL < 5, red line) compared to patients without a disability (ADL ≥ 5, blue line) (3-month mortality, ± 95% CI). p < 0.001 log-rank test
See this image and copyright information in PMC

References

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