Rapid Assessment at Hospital Admission of Mortality Risk From COVID-19: The Role of Functional Status

Abstract

Objective: To evaluate the role of functional status along with other used clinical factors on the occurrence of death in patients hospitalized with COVID-19.

Design: Prospective cohort study.

Setting: Public university hospital (Madrid).

Participants and methods: A total of 375 consecutive patients with COVID-19 infection, admitted to a Public University Hospital (Madrid) between March 1 and March 31, 2020, were included in the Prospective Cohort study. Death was the main outcome. The main variable was disability in activities of daily living (ADL) assessed with the Barthel Index. Covariates included sex, age, severity index (Quick Sequential Organ Failure Assessment, qSOFA), polypharmacy (≥5 drugs in the month before admission), and comorbidity (≥3 diseases). Multivariable logistic regression was used to identify risk factors for adverse outcomes. Estimated model coefficients served to calculate the expected probability of death for a selected combination of 5 variables: Barthel Index, sex, age, comorbidities, and severity index (qSOFA).

Results: Mean age was 66 years (standard deviation 15.33), and there were 207 (55%) men. Seventy-four patients died (19.8%). Mortality was associated with low Barthel Index (odds ratio per 5-point decrease 1.11, 95% confidence interval 1.03-1.20), male sex (0.23, 0.11-0.47), age (1.07, 1.03-1.10), and comorbidity (2.15, 1.08-4.30) but not with qSOFA (1.29, 0.87-1.93) or polypharmacy (1.54, 0.77-3.08). Calculated mortality risk ranged from 0 to 0.78.

Conclusions and implications: Functional status predicts death in hospitalized patients with COVID-19. Combination of 5 variables allows to predict individual probability of death. These findings provide useful information for the decision-making process and management of patients.

Keywords: Barthel Index; COVID-19; disability; function; intensive care; mortality.