Disability, Frailty, and Outcomes After Hospitalization for Covid-19: Results from the PETAL Network BLUE CORAL Study

ABSTRACT

Rationale The relationship between disability and outcomes after COVID-19 hospitalization remains largely unexplored. We hypothesized that patients with pre-COVID disability would have poorer hospital outcomes, and that COVID-19 hospitalization would be associated with increased disability at hospital discharge. Methods: Between August 2020 and July 2021, NHLBI PETAL Network hospitals prospectively enrolled patients hospitalized with symptomatic SARS-CoV2 infection (fever and/or respiratory signs or symptoms) confirmed by molecular testing. Patients or their surrogates reported pre-COVID ability to perform activities of daily living (ADL) and degree of frailty using standardized surveys at study entry (Katz's ADLs and Rockwood's Clinical Frailty Scale (CFS)). Study staff collected detailed clinical data throughout hospitalization. We examined bivariate and multivariable associations between pre-COVID disability and hospital outcomes and reported risk factors for increased disability at hospital discharge among patients surviving to hospital discharge. In analyses exploring factors associated with returning home to living independently or walking at discharge, we excluded patients not living independently or walking prior to COVID admission, respectively. Results: We enrolled 1369 patients across 44 US hospitals. Demographics are presented in the table, along with clinical management and outcomes. Most patients lived at home without help prior to hospitalization (n=1130, 84%), while 14% were dependent in 1-3 ADLs and 14% were dependent in 4 or more. Before hospitalization, 15% of patients were frail (CFS>4) and 15% were vulnerable (CFS=4). Most patients did not receive critical care (“acute illness”);389 patients (28%) were cared for in ICUs (“critical illness”), and 192 (14%) received mechanical ventilation. Overall, 100 (7%) patients died during their COVID-19 hospitalization. Median hospital length of stay was 6 days (IQR 4-8) for acutely ill patients, 14 days (IQR 9-24 days) for critically ill patients. Pre-COVID frailty was independently associated with hospital mortality (OR 3.5, 95% CI 1.9-6.5), adjusting for age and critical illness. Many patients experienced inability to walk and/or return home independently at hospital discharge, which were associated with baseline disability (OR 2.1, 95% CI 1.1-4.1 for inability to walk, OR 1.9, 95% 1.1-3.4 for inability to return home), adjusting for age and critical illness. Conclusion: Disability and frailty are common among patients hospitalized with SARS-CoV2 infection and associated with poorer outcomes. Additionally, COVID hospitalization is associated with increased disability and loss of independence, especially among critically ill patients. Improving recovery and patient centered outcomes after severe SARS-CoV2 hospitalization will likely require careful discharge planning, post-hospital follow-up, and additional research.