Frailty and Mortality in Hospitalized Older Adults With COVID-19: Retrospective Observational Study

Abstract

Objectives: To determine the association between frailty and short-term mortality in older adults hospitalized for coronavirus disease 2019 . Design: Retrospective single-center observational study. Setting and participants: Eighty-one patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of a general hospital in Belgium. Measurements: Frailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical, and radiologic variables, comorbidities, symptoms, and treatment were extracted from electronic medical records. Results: Participants (N ¼ 48 women, 59%) had a median age of 85 years (range 65-97 years) and a median CFS score of 7 (range 2-9); 42 (52%) were long-term care residents. Within 6 weeks, 19 patients died. Mortality was significantly but weakly associated with age (Spearman r ¼ 0.241, P ¼ .03) and CFS score (r ¼ 0.282, P ¼ .011), baseline lactate dehydrogenase (LDH; r ¼ 0.301, P ¼ .009), lymphocyte count (r ¼ À0.262, P ¼ .02), and RT-PCR cycle threshold (Ct, r ¼ À0.285, P ¼ .015). Mortality was not associated with long-term care residence, dementia, delirium, or polypharmacy. In multivariable logistic regression analyses, CFS, LDH, and RT-PCR Ct (but not age) remained independently associated with mortality. Both age and frailty had poor specificity to predict survival. A multivariable model combining age, CFS, LDH, and viral load significantly predicted survival. Conclusions and Implications: Although their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available.

Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.

“…Frail patients were more likely to die than non-frail patients and a dose response relationship was observed between frailty and mortality which persisted after adjustment for age, sex, illness acuity and multimorbidity. This nding has not been consistent across all recent reports, with some supporting our ndings [22,33] and others either equivocal [27] or failing to nd an association [28]. Intuitively, we would expect to nd an association between a clinical syndrome such as frailty, which is de ned by the presence of low physiological reserve and 'vulnerability', and mortality from an acute severe viral illness such as COVID-19.…”

The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19

“…4 , 5 Although frailty has shown to be a reliable predictor of clinical and healthcare-related outcomes in various conditions, 6 , 7 the outcomes of frail older patients diagnosed with COVID-19 remain unclear and arguable. [8][9][10][11][12][13] In the current study, we aimed to assess the prevalence of frailty, the predictive value of frailty for adverse outcomes if any, and lastly, the value of adding frailty to the contemporary comorbidity-based risk adjustment tools in our nationwide COVID-19 patients.…”

Prognostic Value and Reproducibility of AI-assisted Analysis of Lung Involvement in COVID-19 at Low-Dose Submillisievert Chest CT: Sample Size Implications for Clinical Trials

“…Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) is a novel enveloped RNA betacoronavirus belonging to the same family of viruses causing severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) (1). Patients with SARS-CoV-2 infection can develop clinical coronavirus disease 2019 (COVID- 19) which was declared a pandemic by the World Health Organization (WHO) on the 11 th of March 2020 (2,3). The full spectrum of COVID-19 severity is still being clarified but appears to be wide, ranging from asymptomatic status or mild upper respiratory tract symptoms to severe viral pneumonia, multiple organ dysfunction and even death (4).…”