CLINICAL AND FUNCTIONAL CHARACTERIZATION OF ADULTS AND OLDER PEOPLE AFTER SEVERE COVID-19: PRELIMINARY RESULTS OF A COHORT STUDY

E.C.G. Silva¹, C.G. Godoy¹, D.B. Oliveira¹, C.R.F. Carvalho¹, A.C. Gambeta¹, E.M. Silva¹, C.M. Campos¹, A.C. Basso¹, C. Fu¹, D.S. Schujmann¹, C. Tanaka¹, C.T. Junior², G. Correa², L.d.S. Oliveira³, L.C. Nóbrega³, C.R.R. Carvalho², J.E. Pompeu¹

Background: Clinical and functional  characteristics of  individuals with severe COVID-19 are highly relevant for the development of intervention to prevent or treat its impacts on structures and functions.

Purpose: To characterize clinical and functional alterations related to long hospital stays due to COVID-19 in adults and older people.

Methods: This was a prospective cohort study that will follow up 400 adults and older people during a period of one year. To date, we evaluated adults over 18 years both gender after hospitalization by COVID-19 at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil. We collected data of the hospitalized patients in electronic medical records regarding age, gender, weight loss, hospital stay, length of intubation, comorbidities (Charlson Index - IC) and pressure ulcers. Patients were recruited 30 days after hospital discharge. We assessed mobility (Timed Up and Go (TUG)), postural control (Brief BesTest (BBT), muscle strength (Hand Grip) and pulmonary capacity (spirometry). The descriptive statistics were presented by the mean, standard deviation and frequencies. Pearson's coefficient test was used to analyse possible correlation between the variables. Data analysis was performed using the JASP software and a significance level of p <0.05 was adopted.

Results: We assessed 50 individuals, 55% (27/50) participants were men (mean age of 67.18 (5,34) years), body mass index of 29.30 (5.61) and weight loss during hospitalization of 8.94 (7.04) kg. The mean length of hospital stay was 24 (11.77) days, being higher in males (27.81 (13.54) days. The mean intensive care unit stay was 13.33 (7.16) days and length of intubation was 7.71 (5.18) days. In relation to comorbidities, 58% (29/50) presented at least 4 diseases, 100% presented systemic arterial hypertension (SAH) and 67% (34/50) presented pressure ulcers. After hospital discharge, the mean time to complete the TUG was 12.84s (3.00) and the mean BBT score was 15.13 (3.99) points with a negative correlation between TUG and BBT (r=0,586; p=0.003). There was a positive correlation between the handgrip strength and forced vital capacity (FVC), right hand (r= 0,649; p = 0.004) and left hand (r= 0,626; p = 0.005) as well as forced expiratory volume in the first second (FEV1) and right hand (r = 0,640; p = 0.004) and left hand (r= 0,653; p = 0.003). There was a negative correlation between the length of intubation and FVC (r= 0,990; p = 0.001) as well as FEV1 (r= 0,892; p = 0.042). Lastly, there was a positive correlation between the IC and FEV1/FVC ratio (r= 0,508; p = 0.031).

Conclusion(s): The mean length of hospital stays was similar for both adults and older adults affected by COVID-19. Moreover, the long hospital stays are associated with a decline in mobility, postural control, muscle strength and pulmonary capacity.

Implications: Our partial results contribute to the understanding of the clinical characteristics, as well as of the natural history of the disease. We intend to follow 400 patients after hospital discharge to identify predictive factors for functional prognosis and contribute to the development of prevention and rehabilitation strategies.

Funding, acknowledgements: Special acknowledgment to Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) for financial support (process number 402698/2020-7).

Keywords: severe COVID-19, long hospital stays, clinical characterization

Topic: COVID-19

Did this work require ethics approval? Yes

Institution: University of Sao Paulo, Brazil

Committee: School of the University of São Paulo

Ethics number: 32169020.1.0000.0068