The association of the Activities of Daily Living and the outcome of old intensive care patients suffering from COVID-19
Authors: 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 ,   COVIP study group, Eller Philipp , Joannidis Michael , Mesotten Dieter , Reper Pascal , Oeyen Sandra , Swinnen Walter , Serck Nicolas , Dewaele Elisabeth , Brix Helene , Brushoej Jens , Kumar Pritpal , Nedergaard Helene Korvenius , Balleby Ida Riise , Bundesen Camilla , Hansen Maria Aagaard , Uhrenholt Stine , Bundgaard Helle , Fjølner Jesper , Gooch James , Cagova Lenka , Potter Elizabeth , Reay Michael , Davey Miriam , Abusayed Mohammed Abdelshafy , Humphreys Sally , Galbois Arnaud , Guidet Bertrand , Charron Cyril , Berlemont Caroline Hauw , Besch Guillaume , Rigaud Jean-Philippe , Maizel Julien , Djibré Michel , Burtin Philippe , Garcon Pierre , Nseir Saad , Valette Xavier , Alexandru Nica , Marin Nathalie , Vaissiere Marie , Plantefeve Gaëtan , Vanderlinden Thierry , Jurcisin Igor , Megarbane Buno , Chousterman Benjamin Glenn , Dépret François , Garnier Marc , Besset Sebastien , Oziel Johanna , Ferre Alexis , Dauger Stéphane , Dumas Guillaume , Goncalves Bruno , Vettoretti Lucie , Thevenin Didier , Schaller Stefan , Kurt Muhammed , Faltlhauser Andreas , Meyer Christian , Milovanovic Milena , Lutz Matthias , Shala Gonxhe , Haake Hendrik , Randerath Winfried , Kunstein Anselm , Meybohm Patrick , Steiner Stephan , Barth Eberhard , Poerner Tudor , Simon Philipp , Lorenz Marco , Dindane Zouhir , Kuhn Karl Friedrich , Welte Martin , Voigt Ingo , Kabitz Hans-Joachim , Wollborn Jakob , Goebel Ulrich , Stoll Sandra Emily , Kindgen-Milles Detlef , Dubler Simon , Jung Christian , Fuest Kristina , Schuster Michael , Papadogoulas Antonios , Mulita Francesk , Rovina Nikoletta , Aidoni Zoi , Chrisanthopoulou Evangelia , Kondili Eumorfia , Andrianopoulos Ioannis , Groenendijk Martijn , Evers Mirjam , van Lelyveld-Haas Lenneke , Meynaar Iwan , Cornet Alexander Daniel , Zegers Marieke , Dieperink Willem , De Lange Dylan W. , Dormans Tom , Hahn Michael , Sjøbøe Britt , Strietzel Hans Frank , Olasveengen Theresa , Romundstad Luis , Andersen Finn H. , Kluzik Anna , Zatorski Paweł , Drygalski Tomasz , Szczeklik Wojciech , Klimkiewicz Jakub , Solek-pastuszka Joanna , Onichimowski Dariusz , Czuczwar Miroslaw , Gawda Ryszard , Stefaniak Jan , Stefanska-Wronka Karina , Zabul Ewa , Oliveira Ana Isabel Pinho , Assis Rui , de Lurdes Campos Santos Maria , Santos Henrique , Cardoso Filipe Sousa , Gordinho André , Banzo Maria José Arche , Zalba-Etayo Begoña , Cubero Patricia Patricia , Priego Jesús , Gomà Gemma , Tomasa-Irriguible Teresa Maria , Sancho Susana , Ferreira Aida Fernández , Vázquez Eric Mayor , Mira Ángela Prado , Ibarz Mercedes , Iglesias David , Arias-Rivera Susana , Frutos-Vivar Fernando , Lopez-Cuenca Sonia , Aldecoa Cesar , Perez-Torres David , Canas-Perez Isabel , Tamayo-Lomas Luis , Diaz-Rodriguez Cristina , de Gopegui Pablo Ruiz , Ben-Hamouda Nawfel , Roberti Andrea , Fleury Yvan , Abidi Nour , Schefold Joerg C. , Chau Ivan , Dullenkopf Alexander , Pugh Richard , Smuts Sara 
Published: March 2022

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