Abstract
BackgroundThe aim of this study was to describe outcomes in hospitalised older people with different levels of frailty and COVID-19 infection.MethodsWe undertook a single-centre, retrospective cohort study examining COVID-19-related mortality using electronic health records, for older people (65 and over) with frailty, hospitalised with or without COVID-19 infection. Baseline covariates included demographics, early warning scores, Charlson Comorbidity Indices and frailty (Clinical Frailty Scale, CFS), linked to COVID-19 status.FindingsWe analysed outcomes on 1,071 patients with COVID-19 test results (285 (27%) were positive for COVID-19). The mean age at ED arrival was 79.7 and 49.4% were female. All-cause mortality (by 30 days) rose from 9 (not frail) to 33% (severely frail) in the COVID-negative cohort but was around 60% for all frailty categories in the COVID-positive cohort. In adjusted analyses, the hazard ratio for death in those with COVID-19 compared to those without COVID-19 was 7.3 (95% CI: 3.00, 18.0) with age, comorbidities and illness severity making small additional contributions.InterpretationIn this study, frailty measured using the CFS appeared to make little incremental contribution to the hazard of dying in older people hospitalised with COVID-19 infection; illness severity and comorbidity had a modest association with the overall adjusted hazard of death, whereas confirmed COVID-19 infection dominated, with a sevenfold hazard for death.
Highlights
Coronavirus disease 2019 (COVID-19) is a viral illness that currently has no treatment, which impacts upon the course, duration or severity of the disease
Increasing frailty appeared to be associated with greater mortality at 30 days in COVID-19-negative individuals; this was not the case for COVID-19-positive individuals where 63.4 and 65.3% of hospitalised individuals died with Clinical Frailty Scale (CFS) less than 5 and greater than or equal to 5, respectively (Table 2)
Summary is is one of the first studies to report outcomes for older people hospitalised during the COVID-19 pandemic, using prospectively measured grades of frailty. e most striking finding is that frailty, measured using the CFS, appears to make little incremental contribution to estimating hazard of dying
Summary
Coronavirus disease 2019 (COVID-19) is a viral illness that currently has no treatment, which impacts upon the course, duration or severity of the disease. E COVID-19 pandemic has forced countries across the world to consider decisions about escalation for critical care treatment, typically based upon clinicians’ perceptions of who might benefit from organ support, such as invasive ventilation. Age-based outcomes appear to be influencing decisions to offer critical care organ support, rather than looking at frailty in the older person as a marker of potential recovery and ability to benefit from treatment [5]. In the UK, the National Institute for Health and Care Excellence (NICE) guidance NG 159, COVID-19 rapid guideline: critical care in adults advises using the CFS to guide clinical decision-making in older patients relating to discussions of critical care escalation [12]
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