In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19

Abstract

Background: Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly. Methods: This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Republic of Korea from February 2020 to February 2021. We evaluated patients' Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis. Results:The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P < 0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis. Conclusions:The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.

Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes

“…In conclusion, the existing evidence about the association of an atypical presentation with mortality is conflicting, and our study adds to this evidence base. However, it is important that, as in our study, future studies correct for confounders, such as high age, male sex, frailty and higher CRP levels as these are associated with higher mortality in patients with COVID-19 [20,27,[32][33][34][35][36][37]. In addition, we would recommend to investigate whether there is a difference in mortality between patients that present atypically but develop fever, cough or dyspnea later in their disease trajectory and those who do not develop any typical complaints.…”

Evaluation of risk scores as predictors of mortality and hospital length of stay for older COVID‐19 patients

“…The sensitivity of the MuLBSTA appears reliable for elderly patients with COVID‐19. For older patients, the frailty scale and the Sequential Organ Failure Assessment (SOFA) score have been reported as other reliable methods for determining in‐hospital mortality 26 …”

“…For older patients, the frailty scale and the Sequential Organ Failure Assessment (SOFA) score have been reported as other reliable methods for determining in-hospital mortality. 26 The limitations of our study included its retrospective design, unreliable smoking history necessitating all patients being scored as nonsmokers, and acceptance of co-infections based on antibiotic use.…”

Retrospective Study to Identify Risk Factors for Severe Disease and Mortality Using the Modified Early Warning Score in 5127 Patients with COVID-19 Admitted to an Emergency Department in Poland Between March 2020 and April 2021

“…Moreover, based on the multifactor analysis, Gani et al (2022) stated that comorbidities, continuous fever, and MEWS score >3 were factors that led to severe COVID-19 [ 61 ]. It is important to note the important role of early warning scores (eg, MEWS [ 62 – 66 ]) in the assessment and prediction of ICU admission or in-hospital mortality of COVID-19 patients. Wang et al (2020) stated that MEWS is a useful tool for a quick assessment of elderly patients with COVID-19.…”

“…However, this result was not claimed to be statistically significant [ 65 ]. However, a study by Na et al (2022) showed that MEWS scores were higher for patients who died than for patients who survived [ 66 ]. The above mentioned results correspond with our research, which demonstrated that a MEWS score ≥5 is associated with a higher risk of ICU admission and in-hospital mortality.…”