COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants

Abstract

Background Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. Aims We investigated, in the UK Biobank, whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19. Methods 502,640 participants aged 40–69 years at baseline (54–79 years at COVID-19 testing) were recruited across UK during 2006–10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available for 16/03/2020–01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, after adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. Results 4510 participants were tested for COVID-19 (positive = 1326, negative = 3184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥ 4 comorbidity groupings vs 0–1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. However, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. Discussion and conclusions Frailty and multimorbidity do not appear to aid risk stratification, in terms of positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.

Modifiable and non-modifiable risk factors for COVID-19, and comparison to risk factors for influenza and pneumonia: results from a UK Biobank prospective cohort study

“…Of note, the modifiable risk factors explained some of the association of age with COVID-19 in our adjusted model. Since this analysis was conducted, 15 several other studies have also shown the association between modifiable and non-modifiable risk factors and COVID-19 risk, [22][23][24][25][26][27][28][29] particularly with obesity. Generally, these data support our analyses showing the importance of both modifiable and non-modifiable risk factors.…”

The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study

“…Bellelli et al also demonstrated in a cohort of 105 patients that frailty could be used for risk evaluation of COVID-19 and proposed the systematic collection of frailty in all patients at hospital admission [ 11 ]. By contrast, recently published retrospective studies focusing on non-ICU COVID-19 patients found that frailty had no or low diagnostic or prognostic value [ 12 , 13 ]. There is therefore need for more high-quality data on patient outcomes to determine whether frailty, as assessed by the CFS, and in particular its interaction with age can be used for prognostication in critically ill elderly patients with COVID-19 [ 14 ].…”

Association of frailty status with adverse clinical outcomes in patients with COVID-19: protocol for a systematic review and dose–response meta-analysis

“…14 15 Recently, the role of frailty status in mortality for COVID-19-infected patients has received growing attention with controversial results. [16][17][18][19] Some studies also focused on mortality in different categories (>2) of frailty extent. [18][19][20][21][22] Maltese et al 23 performed a related systematic review including only 6 retrospective or prospective trials, 13 editorials, 15 guidelines and 2 case reports; however, no quantitative meta-analysis concerning this important issue has been performed due to the limited data.…”