Pre-Admission Predictors of Walking Independence in Critically Ill Patients

BACKGROUND: Recovery of walking independence in critically ill patients is required for safe discharge home. However, the pre-admission predictors affecting this outcome in this patient group are unknown. This study aimed to identify these predictors.

METHODS: We included subjects who required mechanical ventilation for at least 48 h and could walk before admission. We investigated frailty, cognitive impairment, and malnutrition risk according to the pre-admission health status. Walking independence was defined as the ability to walk for at least 45 m on level ground. The primary outcome was the association between the time to event from an ICU discharge to walking independence, and pre-admission predictors were analyzed using a Fine-Gray proportional hazards regression.

RESULTS: The rate of walking independence was 38.0 (100 cases/person-month; sample N = 144). In the proportional hazards regression model, adjusted for covariates, frailty (hazard ratio [HR] 0.08 [95% CI 0.01–0.67]), pre-frailty (HR 0.37 [95% CI 0.14–0.99]), cognitive impairment (HR 0.21 [95% CI 0.05–0.90]), and malnutrition risk (HR 0.20 [95% CI 0.07–0.58]) were associated with walking independence.

CONCLUSIONS: Pre-admission frailty or pre-frailty, cognitive impairment, and malnutrition risk can help predict walking independence in critically ill patients who require mechanical ventilation.