Patient-Centered Outcomes Following COVID-19: Frailty and Disability Transitions in Critical Care Survivors

Leandro Utino Taniguchi, Thiago Junqueira Avelino-Silva, Murilo Bacchini Dias, Wilson Jacob-Filho, Márlon Juliano Romero Aliberti, COVID-19 and Frailty (CO-FRAIL) Study Group and EPIdemiology of Critical COVID-19 (EPICCoV) Study Group, for COVID Hospital das Clinicas, University of Sao Paulo Medical School (HCFMUSP) Study Group, Amanda Lagreca Venys, Ana Paula Valeriano Medeiros, Bianca Aparecida Garcia, Carolina B Trindade, Christian Douradinho, Cintia Siloto Goulart Figueiredo, Claudia Kimie Suemoto, Claudia Szlejf, Danute B Salotto, Fabio Campos Leonel, Felipe Vecchi Moreira, Gabriel Barros Furtado Léo Borges, Isabela Akie Shin-Ike, Isabella Motim Berger, Joao Francisco Lindenberg Schoueri, José Renato das Graças Amaral, Lara Mune de Oliveira Lima, Leonardo Rabelo de Melo, Leticia Harumi Sumita, Luma Lima e Silva Santos, Lumara Gonçalves Lages, Marcel Hiratsuka, Marcelo Altona, Marlos L V Moreira, Natalia de Castro Carvalho, Natalia Oliveira Trajano da Silva, Otávio Fortes do Rego-Júnior, Paula Cristina Eiras Poco, Paulo Henrique Lazzaris Coelho, Pollyana Clara Gomes Silva, Renata Cunha de Aguiar, Silvia de Fatima Takahashi, Tamires Martins, Valéria de Paula Richinho, Venceslau A Coelho, Victor José Dornelas Melo, Vivian I Avelino-Silva, Adriana Hirota, Alberto Kendy Kanasiro, Alessandra Crescenzi, Amanda Coelho Fernandes, Anna Miethke-Morais, Arthur Petrillo Bellintani, Artur Ribeiro Canasiro, Bárbara Vieira Carneiro, Beatriz Keiko Zanbon, Bernardo Pinheiro De Senna Nogueira Batista, Bianca Ruiz Nicolao, Bruno Adler Maccagnan Pinheiro Besen, Bruno Biselli, Bruno Rocha De Macedo, Caio Machado Gomes De Toledo, Carlos Roberto Ribeiro De Carvalho, Caroline Gomes Mol, Cassio Stipanich, Caue Gasparotto Bueno, Cibele Garzillo, Clarice Tanaka, Daniel Neves Forte, Daniel Joelsons, Daniele Robira, Eduardo Leite Vieira Costa, Elson Mendes Da Silva Júnior, Fabiane Aliotti Regalio, Gabriela Cardoso Segura, Giulia Sefrin Louro, Gustavo Brasil Marcelino, Yeh-Li Ho, Isabela Argollo Ferreira, Jeison de Oliveira Gois, Joao Manoel Da Silva Junior, Jose Otto Reusing Junior, Julia Fray Ribeiro, Juliana Carvalho Ferreira, Karine Vusberg Galleti, Katia Regina Silva, Larissa Padrao Isensee, Larissa dos Santos Oliveira, Leandro Utino Taniguchi, Leila Suemi Letaif, Lígia Trombetta Lima, Lucas Yongsoo Park, Lucas Chaves Netto, Luciana Cassimiro Nobrega, Luciana Haddad, Ludhmila Hajjar, Luiz Marcelo Malbouisson, Manuela Cristina Adsuara Pandolfi, Marcelo Park, Maria José Carvalho Carmona, Maria Castilho Prandini H De Andrade, Mariana Moreira Santos, Matheus Pereira Bateloche, Mayra Akimi Suiama, Mayron Faria de Oliveira, Mayson Laercio Sousa, Michelle Louvaes Garcia, Natassja Huemer, Pedro Mendes, Paulo Ricardo Gessolo Lins, Pedro Gaspar Dos Santos, Pedro Ferreira Paiva Moreira, Renata Mello Guazzelli, Renato Batista Dos Reis, Renato Daltro De Oliveira, Roberta Muriel Longo Roepke, Rodolpho Augusto De Moura Pedro, Rodrigo Kondo, Samia Zahi Rached, Sergio Roberto Silveira Da Fonseca, Thais Sousa Borges, Thalissa Ferreira, Vilson Cobello Junior, Vivian Vieira Tenório Sales, Willaby Serafim Cassa Ferreira, Alberto José da Silva Duarte, Aluisio C Segurado, Amanda C Montal, Anna Miethke-Morais, Anna Sara Shafferman Levin, Beatriz Perondi, Bruno A. M. P. Besen, Carlos R. R. Carvalho, Carolina Mendes do Carmo, Carolina dos Santos Lázari, Clarice Tanaka, Edivaldo M Utiyama, Eloisa Bonfa, Ésper Georges Kallas, Ester Sabino, Fabiane Yumi Ogihara Kawano, Heraldo Possolo de Souza, Izabel Cristina Rios, Izabel Marcilio, Juliana C Ferreira, Julio F. M. Marchini, Leila Harima, Luiz Marcelo Malbouisson, Marcello M. C. Magri, Marcelo C Rocha, Maria Amélia de Jesus, Maria Cristina Peres Braido Francisco, Marjorie F Silva, Maura Salaroli Oliveira, Solange R. G. Fusco, Thaís Guimarães, Tarcisio E. P. Barros-Filho, Yeh-Li Ho, Leandro Utino Taniguchi, Thiago Junqueira Avelino-Silva, Murilo Bacchini Dias, Wilson Jacob-Filho, Márlon Juliano Romero Aliberti, COVID-19 and Frailty (CO-FRAIL) Study Group and EPIdemiology of Critical COVID-19 (EPICCoV) Study Group, for COVID Hospital das Clinicas, University of Sao Paulo Medical School (HCFMUSP) Study Group, Amanda Lagreca Venys, Ana Paula Valeriano Medeiros, Bianca Aparecida Garcia, Carolina B Trindade, Christian Douradinho, Cintia Siloto Goulart Figueiredo, Claudia Kimie Suemoto, Claudia Szlejf, Danute B Salotto, Fabio Campos Leonel, Felipe Vecchi Moreira, Gabriel Barros Furtado Léo Borges, Isabela Akie Shin-Ike, Isabella Motim Berger, Joao Francisco Lindenberg Schoueri, José Renato das Graças Amaral, Lara Mune de Oliveira Lima, Leonardo Rabelo de Melo, Leticia Harumi Sumita, Luma Lima e Silva Santos, Lumara Gonçalves Lages, Marcel Hiratsuka, Marcelo Altona, Marlos L V Moreira, Natalia de Castro Carvalho, Natalia Oliveira Trajano da Silva, Otávio Fortes do Rego-Júnior, Paula Cristina Eiras Poco, Paulo Henrique Lazzaris Coelho, Pollyana Clara Gomes Silva, Renata Cunha de Aguiar, Silvia de Fatima Takahashi, Tamires Martins, Valéria de Paula Richinho, Venceslau A Coelho, Victor José Dornelas Melo, Vivian I Avelino-Silva, Adriana Hirota, Alberto Kendy Kanasiro, Alessandra Crescenzi, Amanda Coelho Fernandes, Anna Miethke-Morais, Arthur Petrillo Bellintani, Artur Ribeiro Canasiro, Bárbara Vieira Carneiro, Beatriz Keiko Zanbon, Bernardo Pinheiro De Senna Nogueira Batista, Bianca Ruiz Nicolao, Bruno Adler Maccagnan Pinheiro Besen, Bruno Biselli, Bruno Rocha De Macedo, Caio Machado Gomes De Toledo, Carlos Roberto Ribeiro De Carvalho, Caroline Gomes Mol, Cassio Stipanich, Caue Gasparotto Bueno, Cibele Garzillo, Clarice Tanaka, Daniel Neves Forte, Daniel Joelsons, Daniele Robira, Eduardo Leite Vieira Costa, Elson Mendes Da Silva Júnior, Fabiane Aliotti Regalio, Gabriela Cardoso Segura, Giulia Sefrin Louro, Gustavo Brasil Marcelino, Yeh-Li Ho, Isabela Argollo Ferreira, Jeison de Oliveira Gois, Joao Manoel Da Silva Junior, Jose Otto Reusing Junior, Julia Fray Ribeiro, Juliana Carvalho Ferreira, Karine Vusberg Galleti, Katia Regina Silva, Larissa Padrao Isensee, Larissa dos Santos Oliveira, Leandro Utino Taniguchi, Leila Suemi Letaif, Lígia Trombetta Lima, Lucas Yongsoo Park, Lucas Chaves Netto, Luciana Cassimiro Nobrega, Luciana Haddad, Ludhmila Hajjar, Luiz Marcelo Malbouisson, Manuela Cristina Adsuara Pandolfi, Marcelo Park, Maria José Carvalho Carmona, Maria Castilho Prandini H De Andrade, Mariana Moreira Santos, Matheus Pereira Bateloche, Mayra Akimi Suiama, Mayron Faria de Oliveira, Mayson Laercio Sousa, Michelle Louvaes Garcia, Natassja Huemer, Pedro Mendes, Paulo Ricardo Gessolo Lins, Pedro Gaspar Dos Santos, Pedro Ferreira Paiva Moreira, Renata Mello Guazzelli, Renato Batista Dos Reis, Renato Daltro De Oliveira, Roberta Muriel Longo Roepke, Rodolpho Augusto De Moura Pedro, Rodrigo Kondo, Samia Zahi Rached, Sergio Roberto Silveira Da Fonseca, Thais Sousa Borges, Thalissa Ferreira, Vilson Cobello Junior, Vivian Vieira Tenório Sales, Willaby Serafim Cassa Ferreira, Alberto José da Silva Duarte, Aluisio C Segurado, Amanda C Montal, Anna Miethke-Morais, Anna Sara Shafferman Levin, Beatriz Perondi, Bruno A. M. P. Besen, Carlos R. R. Carvalho, Carolina Mendes do Carmo, Carolina dos Santos Lázari, Clarice Tanaka, Edivaldo M Utiyama, Eloisa Bonfa, Ésper Georges Kallas, Ester Sabino, Fabiane Yumi Ogihara Kawano, Heraldo Possolo de Souza, Izabel Cristina Rios, Izabel Marcilio, Juliana C Ferreira, Julio F. M. Marchini, Leila Harima, Luiz Marcelo Malbouisson, Marcello M. C. Magri, Marcelo C Rocha, Maria Amélia de Jesus, Maria Cristina Peres Braido Francisco, Marjorie F Silva, Maura Salaroli Oliveira, Solange R. G. Fusco, Thaís Guimarães, Tarcisio E. P. Barros-Filho, Yeh-Li Ho

Abstract

Objectives: As the pandemic advances, the interest in the long-lasting consequences of COVID-19 increases. However, a few studies have explored patient-centered outcomes in critical care survivors. We aimed to investigate frailty and disability transitions in COVID-19 patients admitted to ICUs.

Design: Prospective cohort study.

Setting: University hospital in Sao Paulo.

Patients: Survivors of COVID-19 ICU admissions.

Interventions: None.

Measurements and main results: We assessed frailty using the Clinical Frailty Scale (CFS). We also evaluated 15 basic, instrumental, and mobility activities. Baseline frailty and disability were defined by clinical conditions 2-4 weeks before COVID-19, and post-COVID-19 was characterized 90 days (day 90) after hospital discharge. We used alluvial flow diagrams to visualize transitions in frailty status, Venn diagrams to describe the overlap between frailty and disabilities in activities of daily living, and linear mixed models to explore the occurrence of new disabilities following critical care in COVID-19. We included 428 participants with a mean age of 64 years, 57% males, and a median Simplified Acute Physiology Score-3 score of 59. Overall, 14% were frail at baseline. We found that 124/394 participants (31%) were frail at day 90, 70% of whom were previously non-frail. The number of disabilities also increased (mean difference, 2.46; 95% CI, 2.06-2.86), mainly in participants who were non-frail before COVID-19. Higher pre-COVID-19 CFS scores were independently associated with new-onset disabilities. At day 90, 135 patients (34%) were either frail or disabled.

Conclusions: Frailty and disability were more frequent 90 days after hospital discharge compared with baseline in COVID-19 patients admitted to the ICU. Our results show that most COVID-19 critical care survivors transition to poorer health status, highlighting the importance of long-term medical follow-up for this population.

Trial registration: ClinicalTrials.gov NCT04378582.

Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Figures

Figure 1.
Figure 1.
Transitions between frailty states during the 90 d after hospital discharge. A, Changes in frailty states from pre-COVID-19 (2–4 wk before infection) to 3-mo follow-up among survivors of critical COVID-19. B, The number of patients who transitioned to better frailty states. C, The number of patients who transitioned to worse frailty states. D, The number of patients who had no transition in frailty state. CFS = Clinical Frailty Scale.
Figure 2.
Figure 2.
Venn diagram for the overlap of frailty and disability at 3-mo follow-up. Disability was defined as a Katz Activity of Daily Living (ADL) score ≥ 1 and Frailty as a Clinical Frailty Scale ≥ 5. The overlap of frailty with disability in activities of daily living among those who had one of these two syndromes at 3 mo is shown.
Figure 3.
Figure 3.
Disabilities in all patients and according to Clinical Frailty Scale (CFS) groups. Top, Mean number of disabilities in all patients and across CFS groups in the pre-COVID-19 period (2–4 wk before infection) and 90 d after hospital discharge. Error bars represent se. Bottom, Mean difference in the number of disabilities in all patients and across CFS groups. Differences were between 90 d after hospital discharge and the pre-COVID-19 period (2–4 wk before infection). Error bars represent the 95% CI.

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Source: PubMed

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