新冠肺炎老年重症患者日常生活活动能力与预后的相关性

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

作者信息

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

机构信息

Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.

Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, Paracelsusstraße 37, Oberndorf, 5110, Salzburg, Austria.

出版信息

Ann Intensive Care. 2022 Mar 18;12(1):26. doi: 10.1186/s13613-022-00996-9.

DOI:10.1186/s13613-022-00996-9

PMID:35303201

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8931579/

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.

摘要

目的

患有新型冠状病毒2型疾病（COVID-19）的危重症老年重症监护病房（ICU）患者出现不良结局的风险增加。这项事后分析调查了日常生活活动能力（ADL）与该脆弱患者群体结局之间的关联。

方法

COVIP研究是一项前瞻性国际观察性研究，招募了年龄≥70岁的因COVID-19入院的ICU患者（NCT04321265）。记录了包括ADL（ADL；0 =残疾，6 =无残疾）、临床衰弱量表（CFS）、序贯器官衰竭评估（SOFA）评分、重症监护治疗、ICU生存率和3个月生存率等多个参数。对3个月死亡率进行了多因素校正的混合效应威布尔比例风险回归分析。

结果

这项预先设定的分析纳入了2359例有记录的ADL和CFS的患者。大多数患者在入院前日常生活能够自理（80%的ADL = 6）。无衰弱且无残疾的患者3个月死亡率最低，衰弱（CFS≥5）且残疾（ADL < 6）的患者3个月死亡率最高（52%对78%，p < 0.001）。ADL与3个月死亡率独立相关（ADL作为连续变量：校正风险比[aHR] 0.88（95%置信区间[CI] 0.82 - 0.94，p < 0.001）。即使在对多个混杂因素进行校正后，“残疾”仍导致3个月死亡率显著增加（aHR 1.53（95% CI 1.19 - 1.97，p 0.001）。