ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
This article is part of the Research TopicLong-Term Clinical and Epidemiological Perspectives on Post-Acute Sequelae of SARS-CoV-2 Infection (PASC)View all 9 articles
Functional Decline After Severe COVID-19: Duke Activity Status Index for Preoperative Risk Assessment
Provisionally accepted
Luis Alberto Rodriguez Linares1*
Sarah Cerillo Lopes2- 1Universidade São Paulo, São Paulo, Brazil
- 2Faculdade de Medicina do ABC, Santo André, Brazil
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Abstract. Survivors of severe COVID-19 (Coronavirus Disease 2019) frequently experience long-term functional impairment, a condition known as post-COVID syndrome. As these patients may eventually undergo surgical procedures, evaluating their functional capacity becomes essential for safe anesthetic management. The Duke Activity Status Index (DASI) is a validated, easy-to-administer tool that correlates with cardiopulmonary fitness and surgical risk. Objective: To evaluate changes in functional capacity using DASI scores in patients who survived severe COVID-19, comparing pre-and post-infection performance, and to assess implications for perioperative care. Methods: A retrospective observational study was conducted including 31 patients with a history of severe COVID-19 requiring ICU (Intensive Care Unit) admission. DASI scores were collected before and after hospitalization due to COVID-19. Associations between DASI variation and clinical variables (e.g., presence of pleural effusion, duration of intubation, ICU stay) were also explored. Results: A marked decline in functional capacity was observed after COVID-19, with lower DASI scores post-infection. The presence of pleural effusion and ultrasound abnormalities were associated with more pronounced reductions in DASI scores. A strong correlation was found between duration of intubation and length of hospital stay, and between post-COVID DASI and percentage variation. Conclusion: Severe COVID-19 has a lasting impact on functional capacity as measured by DASI. These findings highlight the need for anesthesiologists to include functional assessments in the preoperative evaluation of patients with a history of severe COVID-19. Integrating DASI into routine pre-anesthetic workup may improve risk stratification and perioperative outcomes in this vulnerable population.
Keywords: COVID-19, Duke activity status index, functional capacity, post-COVID syndrome, Anesthesia, Preoperative evaluation, VO2 max
Received: 05 May 2025; Accepted: 05 Nov 2025.
Copyright: © 2025 Linares and Cerillo Lopes. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Luis Alberto Rodriguez Linares, luisro0729@hotmail.com
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