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. 2023 Jan 24:10:978237.
doi: 10.3389/fpubh.2022.978237. eCollection 2022.

The prognostic value of the Barthel Index for mortality in patients with COVID-19: A cross-sectional study

Erchuan Wang  1 , Ao Liu  1 , Zixuan Wang  1 , Xiaoli Shang  1 , Lingling Zhang  1 , Yan Jin  2 , Yanling Ma  3 , Lei Zhang  1 , Tao Bai  1 , Jun Song  1 , Xiaohua Hou  1
Affiliations

The prognostic value of the Barthel Index for mortality in patients with COVID-19: A cross-sectional study

Erchuan Wang et al. Front Public Health. .

Abstract

Objective: This study aimed to analyze the association between the activity of daily living (ADL), coronavirus disease (COVID-19), and the value of the Barthel Index in predicting the prognosis of patients.

Methods: This study included 398 patients with COVID-19, whose ADL at admission to hospital were assessed with the Barthel Index. The relationship between the index and the mortality risk of the patients was analyzed. Several regression models and a decision tree were established to evaluate the prognostic value of the index in COVID-19 patients.

Results: The Barthel Index scores of deceased patients were significantly lower than that of discharged patients (median: 65 vs. 90, P < 0.001), and its decrease indicated an increased risk of mortality in patients (P < 0.001). After adjusting models for age, gender, temperature, pulse, respiratory rate, mean arterial pressure, oxygen saturation, etc., the Barthel Index could still independently predict prognosis (OR = 0.809; 95% CI: 0.750-0.872). The decision tree showed that patients with a Barthel Index of below 70 had a higher mortality rate (33.3-40.0%), while those above 90 were usually discharged (mortality: 2.7-7.2%).

Conclusion: The Barthel Index is of prognostic value for mortality in COVID-19 patients. According to their Barthel Index, COVID-19 patients can be divided into emergency, observation, and normal groups (0-70; 70-90; 90-100), with different treatment strategies.

Keywords: Barthel Index; COVID-19; activities of daily living; decision tree; prognosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
A graphical abstract of the study. The Barthel Index is significantly associated with the prognosis of COVID-19 patients, and a three-group classification scheme based on the index has been developed to facilitate disease management.
Figure 2
Figure 2
The distribution of the Barthel Index in the deceased and the discharged patients. The histogram shows the obvious difference in the distribution of the Barthel Index between the deceased and discharged patients. Deceased patients are presented on the (Right), while discharged patients are presented on the (Left).
Figure 3
Figure 3
ROC curve of the Barthel Index in patients with COVID-19. ROC curve indicates the sensitivity and specificity of the Barthel Index in predicting the prognosis of patients with COVID-19. The AUC was 0.764 (95%CI: 0.701–0.827).
Figure 4
Figure 4
The training samples and the test samples of the decision tree. By means of the split sample verification, the entire study population is divided into the training samples (n = 197) and the test samples (n = 201). (A) The training samples of the decision tree are divided into three groups which had different mortality. (B) The divided groups in test samples show similar mortality with the corresponding groups in the training samples.
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