Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

Abstract

Background During the first wave of the COVID-19 pandemic older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting. Objective The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands. Methods This was a multi-centre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality. Results A total of 1,376 patients were included (median age 78 years (IQR 74–84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6–9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 vs. 7 days), lower oxygen demand and lower levels of CRP. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared to patients with CFS 1–3, patients with CFS 4–5 had a two times higher risk (odds ratio (OR) 2.0 (95%CI 1.3–3.0) and patients with CFS 6–9 had a three times higher risk of in-hospital mortality (OR 2.8 (95%CI 1.8–4.3)). Conclusions The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.

Frailty as a mortality predictor in older adults with COVID-19: A systematic review and meta-analysis of cohort studies

“…Finally, 22 sources were included in our final analysis 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 . The process used to select study sources is presented in Figure 1 through a PRISMA flow diagram.…”

Clinical frailty score as an independent predictor of outcome in COVID-19 hospitalised patients

“…Another study showed that CFS, but not age, remained independently associated with mortality [23]. Three other studies demonstrated higher in-patient mortality in older and frail patients [12,24,25]. Furthermore, a recent meta-analysis showed that each 1-point increase in CFS was associated with 12% increase in mortality in a linear fashion [26].…”

Association of frailty with outcomes in individuals with COVID‐19: A living review and meta‐analysis

“…Six (11.5%) studies reported unadjusted associations between frailty based on the CFS and receipt of mechanical ventilation (OR 0.32, 95% CI 0.08-1.30; I 2 = 89%; Figure S9). 37,40,43,48,60,64 No studies reported data related to functional outcomes, disability, or quality of life.…”