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Published on: September 30, 2020
Functional Dependence Prior to ICU Admission is Associated with Worse Clinical and Functional Outcomes in Individuals
Darlisson B Paranhos1, Raquel Annoni2, Debora S Schujmann3
1Master's Program in Physiotherapy, Federal University of Triângulo Mineiro and Federal University of Uberlândia, Uberaba, Brazil.
Insights
Patients with COVID-19 admitted to the intensive care unit (ICU) who had low functional capacity (FC) prior to admission faced worse outcomes, including longer hospital stays and higher mortality. Survivors experienced functional decline during their ICU stay, linked to reduced mobility and muscle strength.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Rehabilitation Medicine
Background:
- Coronavirus disease 2019 (COVID-19) has led to significant intensive care unit (ICU) admissions.
- Functional capacity (FC) prior to ICU admission may influence clinical outcomes in critically ill patients.
- Understanding functional decline during ICU stays is crucial for patient recovery.
Purpose of the Study:
- To investigate the association between pre-ICU functional capacity and clinical outcomes in COVID-19 patients.
- To monitor changes in functional capacity from ICU admission to discharge.
- To identify factors related to functional decline during the ICU stay.
Main Methods:
- A prospective observational study involving 108 adult COVID-19 patients admitted to the ICU.
- Functional capacity assessed using the Barthel index (BI) and mobility using the ICU mobility scale at admission and discharge.
- Muscle strength measured by the Medical Research Council (MRC) scale and handgrip test at ICU discharge.
Main Results:
- Pre-ICU functional status was associated with length of hospital stay (OR=1.05) and mortality (OR=5.27).
- Patients experienced an average functional decline of 22.5 points on the BI during their ICU stay.
- Lower mobility and muscle strength (MRC scale) at ICU discharge correlated with greater functional decline during hospitalization.
Conclusions:
- Pre-ICU functional dependence in COVID-19 patients predicts poorer clinical outcomes, including increased hospitalization duration and mortality.
- All surviving COVID-19 patients in the ICU experienced functional decline by the time of discharge, regardless of their initial status.
- Reduced mobility and muscle strength upon ICU discharge are associated with a more significant functional decline experienced during the ICU stay.
Abstract:
Objectives: To determine whether low functional capacity (FC) prior to intensive care unit (ICU) admission due to coronavirus disease 2019 (COVID-19) might be associated with worse clinical outcomes. To monitor FC until discharge from the ICU. To identify associations between physical outcomes and decreased FC at discharge from the ICU. Design: Prospective observational study conducted from March to August 2021. Setting: ICU for adult patients with COVID-19. Participants: Adults (≥18 years) with COVID-19. Interventions: Not applicable. Main outcome measures: Clinical and demographic data were obtained from medical records. At ICU admission, evaluation was made of FC using the Barthel index (BI), and of the level of mobility using the ICU mobility scale. At ICU discharge, FC and mobility level were reassessed, and muscle strength was measured using the Medical Research Council (MRC) scale and the handgrip test. Results: The study was performed with 108 individuals. At the initial assessment, 73.1% of the patients were functionally independent. Length of hospital stay (odds ratio [OR] = 1.05; 95%confidence interval [CI] = 1.00-1.10) and death (OR = 5.27; 95%CI = 1.37-20.28) were related to functional status prior to ICU admission. Between ICU admission and discharge, the BI evaluation indicated a functional decline of 22.5 points. Low mobility level (P = .003) and low muscle strength assessed by the MRC scale (P < .001), measured at ICU discharge, were associated with a greater decrease of FC during the ICU stay. Conclusions: Patients with COVID-19 who were functionally dependent prior to ICU admission presented worse clinical outcomes, with low functional status being associated with longer hospitalization and higher mortality. However, irrespective of the initial functionality status, the surviving individuals suffered from functional decline at ICU discharge. Greater functional decline during the ICU stay was associated with lower muscle strength and lower mobility level at ICU discharge.
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