Abstract
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.
Highlights
Older age is associated with adverse outcomes in COVID-19 patients [1,2,3]
This study is part of a prospective, observational, cohort COronaVIrus surviVAl (COVIVA, ClinicalTrials.gov NCT04366765) study including unselected ED visits of patients aged 18 years and older presenting with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to the emergency department of the University Hospital in Basel, Switzerland, during the first wave of the COVID-19 pandemic between March 2020 and June 2020
Our main interest was the predictive power of frailty status, when adjusted for age, in all patients presenting with suspected COVID-19
Summary
Older age is associated with adverse outcomes in COVID-19 patients [1,2,3]. On the other hand, appears to be a predictor for adverse outcomes in hospitalised COVID-19 patients [4,5,6,7]. Previous meta-analyses addressing the importance of frailty in hospitalised COVID-19 patients showed conflicting results [19,20]. No prospective emergency cohorts with suspected COVID-19, comparing COVID-19 patients with controls, have been published. This is important to emergency department (ED) management, as COVID-19 is often only a suspicion or a working hypothesis. While the COVID-19 status of ED patients with fever and respiratory symptoms is often unknown, age and frailty status can be determined at presentation [8]
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