Frailty in severe COVID-19 survivors after ICU admission. A prospective and multicenter study in Mexico

Abstract

Objective: To analyze the presence of frailty in survivors of severe COVID-19 admitted in the Intensive Care Unit (ICU) and followed six months after discharge.

Design: An observational, prospective and multicenter, nation-wide study.

Setting: Eight adult ICU across eight academic acute care hospitals in Mexico.

Patients: All consecutive adult COVID-19 patients admitted in the ICU with acute respiratory failure between March 8, 2020 to February 28, 2021 were included. Frailty was defined according to the FRAIL scale, and was obtained at ICU admission and 6-month after hospital discharge.

Interventions: None.

Main variables of interest: The primary endpoint was the frailty status 6-months after discharge. A regression model was used to evaluate the predictors during ICU stay associated with frailty.

Results: 196 ICU survivors were evaluated for basal frailty at ICU admission and were included in this analysis. After 6-months from discharge, 164 patients were evaluated for frailty: 40 patients (20.4%) were classified as non-frail, 67 patients (34.2%) as pre-frail and 57 patients (29.1%) as frail. After adjustment, the need of invasive mechanical ventilation was the only factor independently associated with frailty at 6 month follow-up (Odds Ratio [OR] 3.70, 95% confidence interval 1.40-9.81, P = .008).

Conclusions: Deterioration of frailty was reported frequently among ICU survivors with severe COVID-19 at 6-months. The need of invasive mechanical ventilation in ICU survivors was the only predictor independently associated with frailty.

Keywords: COVID-19; Cuidados intensivos; Follow-up; Fragilidad; Frailty; Intensive care unit; Mechanical ventilation; Seguimiento; Ventilación mecánica.