Association between Barthel Index, Grip Strength, and Physical Activity Level at Admission and Prognosis in Community-Acquired Pneumonia: A Prospective Cohort Study

Camilla Koch Ryrsø, Maria Hein Hegelund, Arnold Matovu Dungu, Daniel Faurholt-Jepsen, Bente Klarlund Pedersen, Christian Ritz, Rikke Krogh-Madsen, Birgitte Lindegaard, Camilla Koch Ryrsø, Maria Hein Hegelund, Arnold Matovu Dungu, Daniel Faurholt-Jepsen, Bente Klarlund Pedersen, Christian Ritz, Rikke Krogh-Madsen, Birgitte Lindegaard

Abstract

Background: Impaired functional status is a risk factor for hospitalization in patients with community-acquired pneumonia (CAP). The aim was to determine the influence of functional status and physical activity level on severe outcomes, including length of stay, admission to the intensive care unit (ICU), readmission, and mortality in patients with CAP. Methods: A prospective cohort study among patients hospitalized with CAP. Functional status was assessed with the Barthel index and grip strength, and physical activity level was assessed using the international physical activity questionnaire. Linear regression was used to assess the association with length of stay, and logistic regression was used to assess the risk of severe outcomes. Results: Among 355 patients admitted with CAP, 18% had a low Barthel index (<80), 45% had a low grip strength, and 75% had a low physical activity level. Low Barthel index was associated with increased risk of ICU admission (OR 3.6, 95% CI 1.2−10.9), longer length of stay (27.9%, 95% CI 2.3−59.7%), readmission within 30, 90, and 180 days (OR 2.1−2.4, p < 0.05), and mortality within 90 and 180 days (OR 4.2−5.0, p < 0.05). Low grip strength was associated with increased risk of 90 days readmission (OR 1.6, 95% CI 1.0−2.6, p < 0.05) and mortality within 30, 90, and 180 days (OR 2.6−3.2, p < 0.05). Low physical activity level was associated with increased risk of readmission within 90 and 180 days (OR 1.8−2.1, p < 0.05) and mortality within 30, 90, and 180 days (OR 3.3−5.5, p < 0.05). Conclusions: Impaired functional status and low physical activity level were associated with a longer length of stay and increased risk of ICU admission, readmission, and mortality in patients hospitalized with CAP. Routine assessment of functional status and physical activity level in clinical care could enable early identification of individuals with excess risk for a poor prognosis. Trial registration: ClinicalTrials.gov, NCT03795662.

Keywords: Barthel index; community-acquired pneumonia; grip strength; intensive care unit; length of stay; mortality; physical activity; readmission.

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form and declare support from the Research Council at Copenhagen University Hospital—North Zealand, Denmark, and Grosserer L. F. Foght Foundation for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Association between Barthel index (A) and grip strength (B) and prognosis among 355 patients admitted with community-acquired pneumonia. The association between Barthel index and grip strength and risk for admission to the intensive care unit (ICU), readmission, and mortality were analyzed in an unadjusted logistic regression model (black) and a logistic regression model adjusted for age and sex (white). The patients who died in the hospital are not included in the analyses for readmission.
Figure 2
Figure 2
Association between low Barthel index (A), low grip strength (B), and low physical activity level (C) and prognosis among 355 patients admitted with community-acquired pneumonia. The association between low Barthel index, low grip strength, and low physical activity (PA) level and risk for admission to the intensive care unit (ICU), readmission, and mortality were analyzed in an unadjusted logistic regression model (black) and a logistic regression model adjusted for age (white). The patients who died in the hospital are not included in the analyses for readmission. Low grip strength: <27 kg for males and <16 kg for females. Low physical activity level: <600 MET-min/week vs. moderate (Mod) to high physical activity level: ≥600 MET-min/week. Low Barthel index <80.

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