Demographics, pre-hospital independent status, medical insurance status, laboratory tests and vital signs at ICU admission and at hospital discharge are summarized in Table 1. Aspartate aminotransferase, C-reactive protein, D-dimer, ferritin, lactate dehydrogenase, lymphocyte count, sodium, SpO2, procalcitonin, respiration rate, systolic blood pressure and white-blood cell count were significantly different between groups. Prior to hospital admission, 94.1% of patients were functionally independent, 4.2% partially dependent, and 1.7% dependent. The majority (83%) of patients had medical insurance.
The most prevalent comorbidities were obesity (61%), hypertension (47%), diabetes (30%), and asthma (13%) (Fig. 1A). The percentages of patients with 0, 1, 2, 3, and > 3 comorbidities were 12%, 31%, 19%, 24%, and 14%, respectively (Fig. 1B). In other words, 12% had no, 88% had at least one, 57% had at least two, 38% had at least three, and 14% had at least four comorbidities.
The percentage of patients with recommended discharge to homecare, rehabilitation, LTC/hospice were 27%, 71%, and 2%, respectively (Fig. 2). The percentage of patients with actual discharge to homecare, rehabilitation, LTC/hospice were 49%, 46%, and 5%, respectively. Of those who received rehabilitation recommendation, 16.9% of insured patients and 5% of uninsured patients elected homecare instead. Significantly more discharged patients elected homecare over acute and sub-acute rehabilitation facilities against recommendations (p < 0.001, McNemar’s test).
The percentage of patients who were discharged i) with no equipment, ii) with cane or rolling walker, iii) DME, and iv) to rehabilitation facility were, respectively, 15.25%, 22.03%, 49.15%, and 13.56%, (Fig. 3A). Half (50%) of the patients were discharged with supplemental oxygen equipment of which 9.32% had a tracheotomy and 40.68% did not (Fig. 3B). The remaining 50% of patient were discharged without oxygen equipment.
The major medical follow-up recommendations included cardiology (44%), vascular medicine (26%), pulmonology (15%), endocrinology (15%), neurology (14%), urology (8%), hematology (7%), surgery (8%), and gastroenterology (GI) (7%) (Fig. 4A). The percentages of patients with 0, 1, 2, 3, and > 3 medical follow-up recommendations were 25%, 25%, 22%, 20%, and 8%, respectively (Fig. 4B). In other words, 25% had no, 75% had at least one, 50% had at least two, and 28% had at least three, and 8% had at least four medical follow-up recommendations.
Almost half (45%) of patients had a secondary diagnosis of acute respiratory failure or ARDS during hospitalization and 13% of patients had a secondary diagnosis of AKI. Thromboembolic events were seen in 5% of patients during hospitalization while over a third (34%) of patients received anticoagulation treatment.
Functional scores
For the validation study (N = 18, non-COVID19 ICU patients), the intra-class correlation coefficients between “actual test” scores and “chart review” scores for the modified Mental Status, ICU Mobility Scale, and Barthel Index scores were respectively, 1.00, 0.997, and 0.987, amongst the three independent raters. These high inter-rater agreements suggested that functional scores were well documented on patients’ chart.
About half (53.4%) of the IMV total patients (N = 118) received only physical or occupational therapy, and 46.6% received both. The inter-rater agreement of three raters by interclass correlation coefficients were 0.948, 0.954, and 0.976 for modified Mental Status, ICU Mobility Scale, and Barthel Index scores, respectively. Figure 5 shows the functional status scores at ICU and hospital discharge. All patients showed significant improvement in functional scores at hospital discharge relative to the scores at ICU discharge (p < 0.0001 all three scores, paired t-tests). Functional status of IMV patients were abnormal at hospital discharge.
Figure 6 shows the functional status scores at ICU and hospital discharge versus binned duration on and off IMV. A shorter duration on IMV was correlated with a better ICU Mobility Scale and Barthel Index scores at hospital discharge (p < 0.001 for both scores, ANOVA) but not at ICU discharge (p > 0.05, ANOVA). Duration on IMV were not correlated with Mental Status scores at both ICU and hospital discharge (p > 0.05, ANOVA). There were no correlations with off IMV (p > 0.05, ANOVA).
Functional scores decreased with increasing number of comorbidities at hospital discharge (p < 0.05, ANOVA) but not at ICU discharge (p > 0.05, ANOVA) (Fig. 7). Table 2 shows the correlation of ICU Mobility Scale and Barthel Index scores at hospital discharge with demographics, and comorbidities. Some functional scores were significantly correlated with the age, sex and the presence of pre-existing comorbidities including hypertension, diabetes, chronic obstructive pulmonary disease, and immunosuppression (p < 0.05, ANOVA). Correlations for comorbidities that had < 6% prevalence were not analyzed as they were unreliable.
Table 3 shows the prevalence of in-hospital acquired diagnoses including AKI, acute respiratory failure/ARDS, and thromboembolic events. Barthel Index scores at ICU discharge were significantly correlated with hospital-acquired ARDS (p < 0.05), but not at hospital discharge (p > 0.05). Functional status scores at hospital discharge were not correlated with AKI nor thromboembolic events (p > 0.05).