Predicting Mortality Risk in Older Hospitalized Persons With COVID-19: A Comparison of the COVID-19 Mortality Risk Score with Frailty and Disability

Abstract

Objectives: To assess the association of pre-morbid functional status [Barthel Index (BI)] and frailty [modified Frailty Index (mFI)] with in-hospital mortality and a risk scoring system developed for COVID-19 in patients !75 years diagnosed with COVID-19. Design: Retrospective bicentric observational study. Setting and Participants: Data on consecutive patients aged !75 years admitted with COVID-19 at 2 Italian tertiary care centers were collected from February 22 to May 30, 2020. Methods: Overall, 221 consecutive patients with COVID-19 aged !75 years were admitted to 2 hospitals in the study period and were included in the analysis. Clinical, functional (BI), frailty (mFI), laboratory, and imaging data were collected. Mortality risk on admission was assessed with the COVID-19 Mortality Risk Score (COVID-19 MRS), a dedicated score developed for hospital triage. Results: Ninety-seven (43.9%) patients died. BI, frailty, age, dementia, respiratory rate, PaO 2 /FiO 2 ratio, creatinine, and platelet count were associated with mortality. Analysis of the area under the receiver operating characteristic (AUC) indicated that the predictivity of age was modest and the combination of BI, mFI, and COVID-19 MRS yielded the highest prediction accuracy (AUC COVID-19MRSþBIþmFI vs AUC Age : 0.87 vs 0.59; difference: þ0.28, lower boundeupper bound: 0.17-0.34, P < .001). Conclusions and Implications: Premorbid BI and mFI are associated with mortality and improved the accuracy of the COVID-19 MRS. Functional status may prove useful to guide clinical management of older individuals.

A simple risk score for mortality including the PCR Ct value upon admission in patients hospitalized due to COVID-19

“…The outcomes that have been analyzed ranged from ICU admission and respiratory failure to mortality. In accordance with our findings, age was identified as a significant predictor across studies [ 23 – 28 , 30 – 37 , 39 ]. If its influence was quantified via cutoff values, these mostly ranged between 60 and 75 years [ 25 , 26 , 30 – 32 , 36 , 37 ] and thus were not markedly different from the value of 70 years which we found adequate for all outcomes.…”

Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis

“…for in-hospital mortality Fallon et al [ 47 ] Ireland 25.03.2020–24.04.2020 R/C CFS R/P+ > 65y PCR 86 29 77 n/r Frailty diff. for 30-day mort Fumagalli et al [ 48 ] Italy 22.02.2020–30.05.2020 R/C mFI R > 75y Clin 221 97 82 78–86 134 (60.6) In-hospital mortality Gilis [ 49 ] France 03.03.2020–25.04.2020 P/C CFS P > 75 PCR 186 56 85.3 5.78 92 (49.5) 30-day mortality, ICU admission, laboratory findings, symptoms, delirium, treatment Hewitt [ 50 ] UK, Italy 27.02.2020–28.04.2020 P/C CFS P+ > 18 PCR or Clin 1564 425 74 61–83 903 (57.7) In-hospital mortality; LOH Hoek [ 51 ] …”

“…Two studies presented data on mortality in association with a modified frailty index (mFI) [ 48 , 56 ]. Fumagalli et al included 221 patients aged 75 or older from two centres [ 48 ]. 44.3% of deceased patients were frail in contrast to 29% in survivors.…”

Atrial fibrillation and COVID-19 in older patients: how disability contributes to shape the risk profile. An analysis of the GeroCovid registry

“…In particular, the group with older age and functional dependency showed a mortality risk 10 times higher than their counterparts [ 24 ]. In another experience involving ≥ 75 years patients, pre-infection disability and frailty significantly improved the accuracy of prognostic models, when added to clinical variables commonly used for younger individuals [ 25 ]. Further, in accordance with the existing literature [ 26 ], we found that women not needing oxygen support had the lowest mortality rate .…”