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Available online 8 April 2024
Frailty in severe COVID-19 survivors after ICU admission. A prospective and multicenter study in Mexico
Fragilidad en supervivientes de COVID-19 grave tras el ingreso en UCI. Estudio prospectivo y multicéntrico en México
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Oscar Peñuelasa,
Corresponding author
openuelas@gmail.com

Corresponding author.
, Manuel Lomelíb, Laura del Campo-Albendeac, Sara I. Toledob, Alfredo Arellanod, Uriel Chavarríae, Maria Carmen Marínf, Karina Rosasg, María Alacíen Galván Merlosd, Roberto Mercadoe, Héctor R. García-Lermae, Enrique Monaresh, Daira Gonzálezi, Juan Pérezj, Andrés Esteban-Fernándezk, Alfonso Murielc, Fernando Frutos-Vivara, Andrés Estebana
a Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain
b Hospital H+ Querétaro, Querétaro, Mexico
c Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, Madrid, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
d Hospital de Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico
e Hospital Universitario UANL, Monterrey, Mexico
f Hospital Regional 1º de Octubre ISSSTE, Ciudad de México, Mexico
g Hospital Ángeles Centro Sur, Querétaro, Mexico
h Hospital ABC, Ciudad de México, Mexico
i Hospital Zona 1A Venados, Ciudad de México, Mexico
j Hospital H+ Los Cabos, Baja California Sur, México
k Ingeniero Informático, Madrid, Spain
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Table 1. Baseline characteristics of patients included in the analysis.
Table 2. Early complications (within first seven days of ICU stay) and clinical outcomes in survivors.
Table 3. Univariable model for patients who develop frailty at 6 months of follow up in survivors.
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Abstract
Objective

To analyze the presence of frailty in survivors of severe COVID-19 admitted in the Intensive Care Unit (ICU) and followed six months after discharge.

Design

An observational, prospective and multicenter, nation-wide study.

Setting

Eight adult ICU across eight academic acute care hospitals in Mexico.

Patients

All consecutive adult COVID-19 patients admitted in the ICU with acute respiratory failure between March 8, 2020 to February 28, 2021 were included. Frailty was defined according to the FRAIL scale, and was obtained at ICU admission and 6-month after hospital discharge.

Interventions

None.

Main variables of interest

The primary endpoint was the frailty status 6-months after discharge. A regression model was used to evaluate the predictors during ICU stay associated with frailty.

Results

196 ICU survivors were evaluated for basal frailty at ICU admission and were included in this analysis. After 6-months from discharge, 164 patients were evaluated for frailty: 40 patients (20.4%) were classified as non-frail, 67 patients (34.2%) as pre-frail and 57 patients (29.1%) as frail. After adjustment, the need of invasive mechanical ventilation was the only factor independently associated with frailty at 6 month follow-up (Odds Ratio [OR] 3.70, 95% confidence interval 1.40–9.81, P = .008).

Conclusions

Deterioration of frailty was reported frequently among ICU survivors with severe COVID-19 at 6-months. The need of invasive mechanical ventilation in ICU survivors was the only predictor independently associated with frailty.

Keywords:
Frailty
COVID-19
Intensive care unit
Mechanical ventilation
Follow-up
Resumen
Objetivo

Analizar el deterioro de fragilidad en sobrevivientes de COVID-19 grave ingresados en la Unidad de Cuidados Intensivos (UCI) a los seis meses después del alta.

Diseño

Estudio observacional, prospectivo y multicéntrico, de ámbito nacional.

Ámbito

Ocho UCI en ocho hospitales académicos en México.

Pacientes

Se incluyeron todos los pacientes adultos consecutivos con COVID-19 ingresados en la UCI con insuficiencia respiratoria aguda entre el 8 de marzo de 2020 y el 28 de febrero de 2021. La fragilidad se definió según la escala FRAIL y se obtuvo al ingreso en la UCI y 6 meses después del alta hospitalaria.

Intervenciones

Ninguna.

Variables de interés principales

El objetivo principal fue la fragilidad a los 6 meses después del alta. Se utilizó un modelo de regresión logística para evaluar los predictores durante la estancia en UCI asociados con la fragilidad.

Resultados

196 supervivientes de la UCI se incluyeron en el análisis. A los 6 meses desde el alta, 164 pacientes fueron evaluados: 40 pacientes (20,4%) fueron clasificados como no frágiles, 67 (34,2%) como prefrágiles y 57 pacientes (29,1%) como frágiles. La necesidad de ventilación mecánica invasiva fue el único factor asociado independientemente con la fragilidad a los 6 meses de seguimiento (Odds Ratio [OR] 3,70; intervalo de confianza del 95%: 1,40 a 9,81, P = ,008).

Conclusiones

El deterioro de la fragilidad aparece globalmente en más de la mitad de los supervivientes de la UCI con COVID-19 grave a los 6 meses. La necesidad de ventilación mecánica invasiva en los supervivientes de la UCI fue el único predictor asociado independientemente con la fragilidad.

Palabras clave:
Fragilidad
COVID-19
Cuidados intensivos
Ventilación mecánica
Seguimiento

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