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      Barthel’s Index: A Better Predictor for COVID-19 Mortality Than Comorbidities

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      https://www.riss.kr/link?id=A108289887

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      다국어 초록 (Multilingual Abstract)

      Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel’s index could be a predictor for COVID-19 mortality.Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis.Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17–0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100–4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362–6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795–22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001).Conclusion: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.
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      Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included p...

      Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel’s index could be a predictor for COVID-19 mortality.Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis.Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17–0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100–4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362–6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795–22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001).Conclusion: ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

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      참고문헌 (Reference)

      1 Cosco TD, "What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review" 50 : 608-616, 2021

      2 World Health Organization, "The top 10 causes of death" World Health Organization

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      4 Klang E, "Severe obesity as an independent risk factor for COVID-19 mortality in hospitalized patients younger than 50" 28 : 1595-1599, 2020

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      6 July J, "Prevalence of dementia and its impact on mortality in patients with coronavirus disease 2019 : a systematic review and meta-analysis" 21 : 172-177, 2021

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      10 Rabbani G, "Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19 : a rapid systematic review and meta-analysis" 15 : 705-716, 2021

      1 Cosco TD, "What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review" 50 : 608-616, 2021

      2 World Health Organization, "The top 10 causes of death" World Health Organization

      3 Luo L, "The potential association between common comorbidities and severity and mortality of coronavirus disease 2019 : a pooled analysis" 43 : 1478-1493, 2020

      4 Klang E, "Severe obesity as an independent risk factor for COVID-19 mortality in hospitalized patients younger than 50" 28 : 1595-1599, 2020

      5 Parohan M, "Risk factors for mortality in patients with Coronavirus disease 2019(COVID-19)infection : a systematic review and meta-analysis of observational studies" 23 : 1416-1424, 2020

      6 July J, "Prevalence of dementia and its impact on mortality in patients with coronavirus disease 2019 : a systematic review and meta-analysis" 21 : 172-177, 2021

      7 Singh AK, "Prevalence of co-morbidities and their association with mortality in patients with COVID-19 : a systematic review and meta-analysis" 22 : 1915-1924, 2020

      8 Miettinen M, "Prevalence and risk factors of frailty among home care clients" 17 : 266-, 2017

      9 Tian W, "Predictors of mortality in hospitalized COVID-19 patients : a systematic review and meta-analysis" 92 : 1875-1883, 2020

      10 Rabbani G, "Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19 : a rapid systematic review and meta-analysis" 15 : 705-716, 2021

      11 Booth A, "Population risk factors for severe disease and mortality in COVID-19 : a global systematic review and meta-analysis" 16 : e0247461-, 2021

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      13 Yang H, "Meta-analysis of atrial fibrillation in patients with COVID-19" 144 : 152-156, 2021

      14 Flook M, "Informing the public health response to COVID-19: a systematic review of risk factors for disease, severity, and mortality" 21 : 342-, 2021

      15 Kaur H, "Impact of underlying comorbidities on mortality in SARS-COV-2 infected cancer patients : a systematic review and meta-analysis" 22 : 1333-1349, 2021

      16 Wang Z, "Identification of risk factors for in-hospital death of COVID-19 pneumonia : lessions from the early outbreak" 21 : 113-, 2021

      17 Du Y, "Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19 : a meta-analysis" 31 : 745-755, 2021

      18 Lei H, "Higher mortality in lung cancer patients with COVID-19? A systematic review and meta-analysis" 157 : 60-65, 2021

      19 Mahoney FI, "Functional evaluation : the Barthel Index" 14 : 61-65, 1965

      20 Ng TP, "Frailty in older persons : multisystem risk factors and the Frailty Risk Index(FRI)" 15 : 635-642, 2014

      21 Zhang XM, "Frailty as a predictor of mortality among patients with COVID-19 : a systematic review and meta-analysis" 21 : 186-, 2021

      22 Fhon JR, "Factors associated with frailty in older adults : a longitudinal study" 52 : 74-, 2018

      23 Chidambaram V, "Factors associated with disease severity and mortality among patients with COVID-19 : a systematic review and meta-analysis" 15 : e0241541-, 2020

      24 Li J, "Epidemiology of COVID-19: a systematic review and meta-analysis of clinical characteristics, risk factors, and outcomes" 93 : 1449-1458, 2021

      25 Shang L, "Diabetes mellitus is associated with severe infection and mortality in patients with COVID-19 : a systematic review and meta-analysis" 51 : 700-709, 2020

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      27 Zodpey SP, "Determinants of severity among hospitalised COVID-19 patients: hospital-based case-control study, India, 2020" 16 : e0261529-, 2021

      28 Xiang G, "Clinical risk factors for mortality of hospitalized patients with COVID-19 : systematic review and meta-analysis" 10 : 2723-2735, 2021

      29 Liu Y, "Clinical risk factors for mortality in patients with cancer and COVID-19: a systematic review and meta-analysis of recent observational studies" 21 : 107-119, 2021

      30 Becerra-Munoz VM, "Clinical profile and predictors of in-hospital mortality among older patients hospitalised for COVID-19" 50 : 326-334, 2021

      31 Pranata R, "Clinical frailty scale and mortality in COVID-19 : a systematic review and dose-response meta-analysis" 93 : 104324-, 2021

      32 COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators, "Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study" 47 : 60-73, 2021

      33 Silverio A, "Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: systematic review and meta-analysis of 45 studies and 18,300 patients" 21 : 23-, 2021

      34 Gomez-Belda AB, "COVID-19 in older adults : what are the differences with younger patients?" 21 : 60-65, 2021

      35 World Health Organization, "COVID-19 Clinical management : living guidance" World Health Organization 2021

      36 Ip RJ, "Atrial fibrillation as a predictor of mortality in high risk COVID-19 patients : a multicentre study of 171 patients" 30 : 1151-1156, 2021

      37 Kalligeros M, "Association of obesity with disease severity among patients with coronavirus disease 2019" 28 : 1200-1204, 2020

      38 Du Y, "Association of body mass index(BMI)with critical COVID-19 and in-hospital mortality : a dose-response meta-analysis" 117 : 154373-, 2021

      39 Thakur B, "A systematic review and meta-analysis of geographic differences in comorbidities and associated severity and mortality among individuals with COVID-19" 11 : 8562-, 2021

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