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

Raphael Romano Bruno, Bernhard Wernly, Hans Flaatten, Jesper Fjølner, Antonio Artigas, Philipp Heinrich Baldia, Stephan Binneboessel, Bernardo Bollen Pinto, Joerg C Schefold, Georg Wolff, Malte Kelm, Michael Beil, Sigal Sviri, Peter Vernon van Heerden, Wojciech Szczeklik, Muhammed Elhadi, Michael Joannidis, Sandra Oeyen, Eumorfia Kondili, Brian MarshJakob Wollborn, Finn H Andersen, Rui Moreno, Susannah Leaver, Ariane Boumendil, Dylan W De Lange, Bertrand Guidet, Christian Jung

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)26
JournalAnnals of Intensive Care
Volume12
Issue number1
DOIs
Publication statusPublished - 18 Mar 2022

Fingerprint

Dive into the research topics of 'The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19'. Together they form a unique fingerprint.

Cite this