Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study

Abstract

Background Coronavirus disease 2019 (COVID‐19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID‐19 patients. Methods A total of 471 patients with polymerase chain reaction‐confirmed COVID‐19 were followed up for 9 months [median (inter‐quartile range) of follow‐up time: 271 (14) days] after hospital admission. COVID‐19‐related signs and symptoms, laboratory features, co‐morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. Results A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval—CI): 4C : 1.34 (1.25–1.45); CFS : 1.49 (1.33–1.66)] and late [OR (95% CI): 4C : 1.23 (1.12–1.36); CFS : 2.04 (1.62–2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732–0.825) vs. 0.723 (0.673–0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776–0.883) vs. 0.724 (0.650–0.798), respectively; P = 0.007]. Conclusions In our cohort, late mortality in COVID‐19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase.

Impact of dementia, living in a long-term care facility, and physical activity status on COVID-19 severity in older adults

“…In addition, the ATT for dementia showed a negative impact on its severity. These results are not in agreement with those of previous studies [22,23,31,32], and dementia itself would not intuitively seem to have a positive effect on the severity of COVID-19. However, two reports from Japan stated that dementia was not a significant risk factor for severe illness due to COVID-19 [6,33].…”

A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients

“…Previous large multicenter studies have established the critical role of existing comorbidities for the development of severe disease or death among hospitalized patients who received, or not, variable treatments for COVID-19 [ 2 , 5 ]. Aging, male sex, cardiovascular risk factors and cardiovascular disease, kidney and lung dysfunction, cancer and autoimmune diseases have been associated with worse clinical outcomes among patients with COVID-19 [ 2 , 5 , 23 ]. In the presence of comorbidities, the classic pneumonia scores such as CURB-65 and PSI [ 24 , 25 ] as well as a quicker clinical score, namely qSOFA [ 26 , 27 ], have shown a good correlation with poor prognosis.…”

Frailty trajectories in community‐dwelling older adults during COVID‐19 pandemic: The PRESTIGE study

“… 6 , 34 , 35 Moreover, levels of frailty condition pre‐infection have been associated with increased care needs after hospitalization and poorer long‐term survival also regardless of features of acute infection. 12 , 13 , 34 Parallelly, frailty has been deemed as a criterion for less aggressive approaches. Indeed, among older adults resident in long‐term care the COVID‐19 positivity and the presence of frailty condition were associated with a de‐escalation of care plans.…”

“…mortality at short‐ as well as long term, length of hospital stay, higher incidence of admission to intensive care units and need of invasive mechanical ventilation). 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Frail subjects may commonly experience atypical presentation of the COVID‐19 disease including hypotension, sudden functional decline, falls, and delirium, which may lead to diagnostic delay and further spread of infection. 14 …”