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. Methods We 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 (group 1: alive or group 2: deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) curves were generated by following the outcome in all patients until 12 May 2020. Results The 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 (group 2: 63 vs group 1: 37%, p < 0.001), with a higher prevalence of cardiovascular disease (group 2: 58 vs group 1: 33%, p < 0.001) and respiratory diseases (group 2: 38 vs group 1: 25%, p = 0.03). 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 significant predictors of inpatient mortality. KM curves showed a significantly shorter survival time in the frail older patients. Conclusion Older age and frailty are chief 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.

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

“…Three small and underpowered studies showed no association [14][15][16]. Given recent articles exploring this association between frailty and mortality [17][18][19][20][21][22][23], we believe that there is an urgent need to summarize the evidence of this important issue. The objective of our study is to systematically review and quantify the results of the associations between frailty and mortality, which could provide evidencebased suggestions for clinicians.…”

“…A global pandemic of coronavirus disease 2019 (COVID- 19) was first reported in Wuhan city, China, in December 2019 [1]. The total number of confirmed cases was 96,877, 399 worldwide on 23 January 2021 (https://www.…”

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

“…Interestingly, studies reporting the association of frailty with poor outcomes in the COVID-19 pandemic have shown conflicting results. Although frailty was associated with increased mortality in multiple studies [ 3–9 ], in some studies it was not [ 2 , 10 ]. Potential explanations for these inconsistent findings may be of a methodological nature, including differences in patients’ selection (partially due to different healthcare systems), relatively small sample sizes and single-centre studies.…”

2020: The Year of the COVID-19 Pandemic

“…COVID-19 has worse outcomes in older persons especially if they are frail ( 1 – 3 ). Persons with hypertension, diabetes mellitus, and heart failure also have worse outcomes.…”