<scp>COVID</scp>‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

Aliberti, Márlon Juliano Romero; Szlejf, Cláudia; Avelino‐Silva, Vivian Iida; Suemoto, Cláudia Kimie; Apolinário, Daniel; Dias, Murilo Bacchini; Garcez, Flávia Barreto; Trindade, Carolina B.; Amaral, José Renato das Graças; Melo, Lucas da Ponte; Aguiar, Renata Cunha; Coelho, Paulo Henrique Lazzaris; Hojaij, Naira Hossepian Salles de Lima; Saraiva, Marcos Daniel; Silva, Natalia Oliveira Trajano; Jacob‐Filho, Wilson; Avelino‐Silva, Thiago Junqueira

doi:10.1111/jgs.17146

Cited by 68 publications

(115 citation statements)

References 50 publications

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“…All sixteen corresponding authors were invited to participate and share their original individual patient data. We included seven studies [22,26,29,31,32,36,37] that provided individual patient data on 9332 hospitalisations (Supplementary Fig. 1), of these, 3690 (39.5%) patients were deemed frail.…”

Section: Resultsmentioning

confidence: 99%

“…The corresponding authors of eligible studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] (Supplementary Table 1) were invited to participate and share their original individual patient data. We included studies that reported on adults aged ≥ 18 years with laboratory-con rmed symptomatic COVID-19 patients, a documented CFS score and admitted to ICU.…”

Section: Eligibility Criteriamentioning

confidence: 99%

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Characteristics and Outcomes of Frail Patients with COVID-19 Admitted to ICU: An Individual Patient Data Meta-Analysis

Subramaniam

Anstey

Curtis

et al. 2021

Preprint

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Purpose: Frailty is often used in clinical decision-making for patients with COVID-19, yet studies have found variable influence of frailty on outcomes in those admitted to the intensive care unit (ICU). In this individual patient data meta-analysis, we evaluated the characteristics, and outcomes of frail patients admitted to ICU with COVID-19.Methods: We contacted the corresponding authors of sixteen eligible studies published between December 1st 2019 and February 28th 2021 reporting the clinical frailty scale (CFS) in patients with confirmed COVID-19 admitted to ICU. Individual patient data was obtained from 7 studies. We classified patients as non-frail (CFS=1-4) or frail (CFS=5-8). The primary outcome was hospital mortality. We also compared the use of mechanical ventilation (MV) and the proportion of ICU bed-days between frailty categories. Results: Of the 2001 patients admitted to ICU, 388 (19.4%) were frail. Increasing age and sequential organ failure assessment (SOFA) score, CFS ≥4, use of MV, vasopressors, renal replacement therapy and hyperlactatemia were risk factors for death in a multivariable analysis. Hospital mortality was higher in frail patients (65.2% vs. 41.8%; p<0.001), with adjusted mortality increasing with a rising CFS score beyond 3. Younger and non-frail patients were more likely to receive MV. Frail patients spent less time on MV (median days [IQR] 9 [5-16] vs. 11 [6-18]; p=0.012) and accounted for only 12.3% of total ICU bed-days. Conclusion: Frail patients with COVID-19 were commonly admitted to ICU and had greater hospital mortality but spent relatively fewer days in ICU when compared with non-frail patients. Frail patients receiving MV were at greater risk of death than non-frail patients. Systematic review registration: Registration protocol in PROSPERO (CRD42020224255).

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Section: Resultsmentioning

confidence: 99%

Section: Eligibility Criteriamentioning

confidence: 99%

Characteristics and Outcomes of Frail Patients with COVID-19 Admitted to ICU: An Individual Patient Data Meta-Analysis

Subramaniam

Anstey

Curtis

et al. 2021

Preprint

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“…Most previous studies on the topic have shown data from hospitalised patients or specialized units [4][5][6][7][14][15][16][17][18][19][20][30][31][32][33][34][35]. Frailty status could be helpful for resource allocation, due to high odds for adverse outcomes.…”

Section: Discussionmentioning

confidence: 99%

Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection

Simon

Jauslin

Rueegg

et al. 2021

JCM

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Older age and frailty are predictors of adverse outcomes in patients with COVID-19. In emergency medicine, patients do not present with the diagnosis, but with suspicion of COVID-19. The aim of this study was to assess the association of frailty and age with death or admission to intensive care in patients with suspected COVID-19. This single-centre prospective cohort study was performed in the Emergency Department of a tertiary care hospital. Patients, 65 years and older, with suspected COVID-19 presenting to the Emergency Department during the first wave of the pandemic were consecutively enrolled. All patients underwent nasopharyngeal SARS-CoV-2 PCR swab tests. Patients with a Clinical Frailty Scale (CFS) > 4, were considered to be frail. Associations between age, gender, frailty, and COVID-19 status with the composite adverse outcome of 30-day-intensive-care-admission and/or 30-day-mortality were tested. In the 372 patients analysed, the median age was 77 years, 154 (41.4%) were women, 44 (11.8%) were COVID-19-positive, and 125 (33.6%) were frail. The worst outcome was seen in frail COVID-19-patients with six (66.7%) adverse outcomes. Frailty (CFS > 4) and COVID-19-positivity were associated with an adverse outcome after adjustment for age and gender (frailty: OR 5.01, CI 2.56–10.17, p < 0.001; COVID-19: OR 3.47, CI 1.48–7.89, p = 0.003). Frailty was strongly associated with adverse outcomes and outperformed age as a predictor in emergency patients with suspected COVID-19.

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“…We invited geriatrics fellows to participate in the CO-FRAIL Study, designed to investigate frailty and adverse outcomes in patients with COVID-19. 6 The study was conducted at Hospital das Clinicas, University of Sao Paulo, the largest academic medical complex in Latin America. 7 We used a development approach to reconcile the new research work with other geriatrics training activities (Supplementary Figure S1).…”

Section: Methodsmentioning

confidence: 99%

“Part of a great team”: Perceptions of geriatrics fellows on doing research during a pandemic

Berjeaut

Carvalho

Aliberti

et al. 2021

J American Geriatrics Society

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COVID‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients

Cited by 68 publications

References 50 publications

Characteristics and Outcomes of Frail Patients with COVID-19 Admitted to ICU: An Individual Patient Data Meta-Analysis

Characteristics and Outcomes of Frail Patients with COVID-19 Admitted to ICU: An Individual Patient Data Meta-Analysis

Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection

“Part of a great team”: Perceptions of geriatrics fellows on doing research during a pandemic

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