Older Age and Frailty are the Chief Predictors of Mortality in COVID-19 Patients Admitted to an Acute Medical Unit in a Secondary Care Setting- A Cohort Study

Abstract

Background There is a need for more observational studies across different clinical settings to better understand the epidemiology of the novel COVID-19 infection. Evidence on clinical characteristics of COVID-19 infection is scarce in secondary care settings in Western populations.MethodsWe describe the clinical characteristics of all consecutive COVID-19 positive patients (n=215) admitted to the acute medical unit at Fairfield General Hospital (secondary care setting) between 23 March 2020 and 30 April 2020 based on the outcome at discharge (alive or deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) charts were generated by following the outcome in all patients until 12 May 2020. ResultsThe median age of our cohort was 74 years with a predominance of Caucasians (87.4%) and males (62%). Of the 215 patients, 86 (40%) died. A higher proportion of patients who died were frail (63 vs 37%, p<0.001), with a higher prevalence of cardiovascular disease (50 vs 33%, p<0.001) and respiratory diseases (38 vs 25 %, p=0.034). In the multivariate logistic regression models, older age (odds ratio (OR) 1.03; p=0.03), frailty (OR 5.1; p<0.001) and lower estimated glomerular filtration rate (eGFR) on admission (OR 0.98; p=0.01) were strong and independent predictors of inpatient mortality. KM charts showed a clear difference in survival outcome in the frail older patients. ConclusionOlder age and frailty are strong and independent risk factors associated with mortality in COVID-19 patients hospitalised to an acute medical unit at secondary care level. A holistic approach by incorporating these factors is warranted in the management of patients with COVID-19 infection.

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

“…The most common health outcome reported was mortality (37 studies; 71.2%). 8,19,23,24,26,27,29,[31][32][33][34][35][36][37][40][41][42][43][44][45][47][48][49][50][51][52][54][55][56][57]59,[62][63][64][65]68,69 The pooled odds ratio (OR) for unadjusted data associating frailty based on the CFS with mortality was 2.02 (95% confidence interval [CI] 1.62-2.51; I 2 83%; Figure S1). All studies adjusted for age, a majority controlled for comorbidity and sex, while other factors like COVID severity, laboratory values, and socioeconomic indicators were variably adjusted for.…”