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.

中文翻译：

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COVID-19 后以患者为中心的结果：重症监护幸存者的虚弱和残疾转变*

目标： 

随着疫情的蔓延，人们对 COVID-19 的长期后果的兴趣与日俱增。然而，一些研究探讨了重症监护幸存者中以患者为中心的结果。我们的目的是调查入住 ICU 的 COVID-19 患者的虚弱和残疾转变。

设计： 

前瞻性队列研究。

环境： 

圣保罗大学医院。

患者： 

COVID-19 入住 ICU 的幸存者。

干预措施： 

没有任何。

测量和主要结果： 

我们使用临床衰弱量表（CFS）评估衰弱程度。我们还评估了 15 项基础、工具性和流动性活动。基线虚弱和残疾是根据 COVID-19 发生前 2-4 周的临床状况来定义的，而 COVID-19 后的特征则是在出院后 90 天（第 90 天）进行表征。我们使用冲积流图来可视化虚弱状态的转变，使用维恩图来描述日常生活活动中虚弱和残疾之间的重叠，并使用线性混合模型来探索在 COVID-19 重症监护后新残疾的发生。我们纳入了 428 名参与者，平均年龄为 64 岁，其中 57% 为男性，简化急性生理学评分 3 分中位数为 59 分。总体而言，14% 的参与者在基线时身体虚弱。我们发现 124/394 名参与者 (31%) 在第 90 天时感到虚弱，其中 70% 之前并不虚弱。残疾人数也有所增加（平均差，2.46；95% CI，2.06-2.86），主要是在 COVID-19 之前身体状况良好的参与者中。COVID-19 之前较高的 CFS 评分与新发残疾独立相关。第 90 天时，135 名患者 (34%) 变得虚弱或残疾。

结论： 

与基线相比，入住 ICU 的 COVID-19 患者在出院 90 天后出现虚弱和残疾的情况更为频繁。我们的结果显示，大多数 COVID-19 重症监护幸存者的健康状况变得较差，这凸显了长期医疗随访对该人群的重要性。