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 Schefold , Georg Wolff , Malte Kelm , Michael Beil , Sigal Sviri , Peter Vernon van Heerden , Wojciech Szczeklik , Muhammed Elhadi , Michael Joannidis , Sandra Oeyen , Eumorfia Kondili , Brian Marsh , Jakob Wollborn , Finn Andersen , Rui Moreno , Susannah Leaver , Ariane Boumendil (1) , Dylan de Lange , Bertrand Guidet (1) , Christian Jung , Philipp Eller , Michael Joannidis , Dieter Mesotten , Pascal Reper , Sandra Oeyen , Walter Swinnen , Nicolas Serck , Elisabeth Dewaele , Helene Brix , Jens Brushoej , Pritpal Kumar , Helene Korvenius Nedergaard , Ida Riise Balleby , Camilla Bundesen , Maria Aagaard Hansen , Stine Uhrenholt , Helle Bundgaard , Jesper Fjølner , James Gooch , Lenka Cagova , Elizabeth Potter , Michael Reay , Miriam Davey , Mohammed Abdelshafy Abusayed , Sally Humphreys , Arnaud Galbois , Bertrand Guidet , Cyril Charron , Caroline Hauw Berlemont , Guillaume Besch , Jean-Philippe Rigaud , Julien Maizel (2) , Michel Djibré , Philippe Burtin , Pierre Garcon , Saad Nseir , Xavier Valette , Nica Alexandru , Nathalie Marin , Marie Vaissiere , Gaëtan Plantefeve , Thierry Vanderlinden , Igor Jurcisin , Buno Megarbane , Benjamin Glenn Chousterman , François Dépret , Marc Garnier , Sebastien Besset , Johanna Oziel , Alexis Ferre , Stéphane Dauger , Guillaume Dumas , Bruno Goncalves , Lucie Vettoretti , Didier Thevenin , Stefan Schaller , Muhammed Kurt , Andreas Faltlhauser , Christian Meyer , Milena Milovanovic , Matthias Lutz , Gonxhe Shala , Hendrik Haake , Winfried Randerath , Anselm Kunstein , Patrick Meybohm , Stephan Steiner , Eberhard Barth , Tudor Poerner , Philipp Simon , Marco Lorenz , Zouhir Dindane , Karl Friedrich Kuhn , Martin Welte , Ingo Voigt , Hans-Joachim Kabitz , Jakob Wollborn , Ulrich Goebel , Sandra Emily Stoll , Detlef Kindgen-Milles , Simon Dubler , Christian Jung , Kristina Fuest , Michael Schuster , Antonios Papadogoulas , Francesk Mulita , Nikoletta Rovina , Zoi Aidoni , Evangelia Chrisanthopoulou , Eumorfia Kondili , Ioannis Andrianopoulos , Martijn Groenendijk , Mirjam Evers , Lenneke van Lelyveld-Haas , Iwan Meynaar , Alexander Daniel Cornet , Marieke Zegers , Willem Dieperink , Dylan de Lange , Tom Dormans , Michael Hahn , Britt Sjøbøe , Hans Frank Strietzel , Theresa Olasveengen , Luis Romundstad , Finn Andersen , Anna Kluzik , Paweł Zatorski , Tomasz Drygalski , Wojciech Szczeklik , Jakub Klimkiewicz , Joanna Solek-Pastuszka , Dariusz Onichimowski , Miroslaw Czuczwar , Ryszard Gawda , Jan Stefaniak , Karina Stefanska-Wronka , Ewa Zabul , Ana Isabel Pinho Oliveira , Rui Assis , Maria de Lurdes Campos Santos , Henrique Santos , Filipe Sousa Cardoso , André Gordinho , Maria José Arche Banzo , Begoña Zalba-Etayo , Patricia Patricia Cubero , Jesús Priego , Gemma Gomà , Teresa Maria Tomasa-Irriguible , Susana Sancho , Aida Fernández Ferreira , Eric Mayor Vázquez , Ángela Prado Mira , Mercedes Ibarz , David Iglesias , Susana Arias-Rivera , Fernando Frutos-Vivar , Sonia Lopez-Cuenca , Cesar Aldecoa , David Perez-Torres , Isabel Canas-Perez , Luis Tamayo-Lomas , Cristina Diaz-Rodriguez , Pablo Ruiz de Gopegui , Nawfel Ben-Hamouda , Andrea Roberti , Yvan Fleury , Nour Abidi , Joerg Schefold , Ivan Chau , Alexander Dullenkopf , Richard Pugh , Sara Smuts

1 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
2 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

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

Mots clés: Sars-CoV-2; COVID-19; Intensive care unit ICU

Domaines: Sciences du Vivant [q-bio]

Raphael Romano Bruno, Bernhard Wernly, Hans Flaatten, Jesper Fjølner, Antonio Artigas, et al.. The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19. Annals of Intensive Care, 2022, 12 (1), pp.26. ⟨10.1186/s13613-022-00996-9⟩. ⟨hal-03820467⟩