Association between Clinical Frailty Scale (CFS) and clinical presentation and outcomes in older inpatients with COVID-19

Abstract

Background Frailty is a physiological condition characterized by a decreased reserve to stressors. In patients with COVID-19, frailty is a risk factor for in-hospital mortality. The aim of this study was to assess the relationship between clinical presentation, analytical and radiological parameters at admission, and clinical outcomes according to frailty, as defined by the Clinical Frailty Scale (CFS), in old people hospitalized with COVID-19. Materials and methods This retrospective cohort study included people aged 65 years and older and admitted with community-acquired COVID-19 from 3 March 2020 to 31 April 2021. Patients were categorized using the CFS. Primary outcomes were symptoms of COVID-19 prior to admission, mortality, readmission, admission in intensive care unit (ICU), and need for invasive mechanical ventilation. Analysis of clinical symptoms, clinical outcomes, and CFS was performed using multivariable logistic regression, and results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Results Of the 785 included patients, 326 (41.5%, 95% CI 38.1%–45.0%) were defined as frail (CFS ≥ 5 points): 208 (26.5%, 95% CI 23.5%–29.7%) presented mild-moderate frailty (CFS 5–6 points) and 118 (15.0%, 95% CI 12.7%–17.7%), severe frailty (7–9 points). After adjusting for epidemiological variables (age, gender, residence in a nursing home, and Charlson comorbidity index), frail patients were significantly less likely to present dry cough (OR 0.58, 95% CI 0.40–0.83), myalgia-arthralgia (OR 0.46, 95% CI 0.29–0.75), and anosmia-dysgeusia (OR 0.46, 95% CI 0.23-0.94). Confusion was more common in severely frail patients (OR 3.14; 95% CI 1.64-5.97). After adjusting for epidemiological variables, the risk of in-hospital mortality was higher in frail patients (OR 2.79, 95% CI 1.79-4.25), including both those with mild-moderate frailty (OR 1.98, 95% CI 1.23-3.19) and severe frailty (OR 5.44, 95% CI 3.14-9.42). Readmission was higher in frail patients (OR 2.11, 95% CI 1.07–4.16), but only in mild-moderate frailty (OR 2.35, 95% CI 1.17–4.75).. Conclusion Frail patients presented atypical symptoms (less dry cough, myalgia-arthralgia, and anosmia-dysgeusia, and more confusion). Frailty was an independent predictor for death, regardless of severity, and mild-moderate frailty was associated with readmission.

Fecal microbiota transplantation for recurrent Clostridioides difficile infection in frail and very old patients

“…Finally, in a subgroup of patients of the present cohort, the CFS calculation was obtained retrospectively by extrapolation of available data, in line with previous studies. 8,19 Nevertheless, the consistency and reliability of retrospectively calculated CFS may deserve further validation and our conclusions regarding the association of CFS with the clinical outcomes should be confirmed in prospective studies.…”

“…16 Frailty was assessed by the "Clinical Frailty Scale" (CFS), 17 based on the patients' condition 2 weeks before hospital admissions. If the CFS score was not recorded, in line with other previous studies, 18,19 our geriatric team retrospectively estimated CSF by review of specific electronic medical records, including medical and nursing notes, information about the physical function, and assistance required for feeding, washing, and dressing. The retrospective CFS assessment was validated for consistency and reproducibility by comparing it with the values calculated by two independent physicians, blinded to the geriatric team evaluation.…”

The predictive power of data: machine learning analysis for Covid-19 mortality based on personal, clinical, preclinical, and laboratory variables in a case–control study

“…Symptoms such as productive cough, dyspnea, and delirium are significantly associated with COVID-19 mortality, emphasizing the need for immediate monitoring and intervention [ 56 ]. Laboratory tests show altered hematologic and biochemical markers in deceased patients, underscoring the importance of routine laboratory monitoring in COVID-19 patients [ 57 , 58 ].…”

Hospitalized COVID‐19 patients with diabetes have an increased risk for pneumonia, intensive care unit requirement, intubation, and death: A cross‐sectional cohort study in Mexico in 2020

“…Numerous studies have demonstrated that COVID‐19 patients who also have conditions like hypertension, diabetes, and obesity typically experience worse outcomes 55,57,58 . The body's capacity to mount an immune response against viral infections can be hindered by these comorbidities, which can disrupt the immune system's normal function 59,60 …”

“… 55 , 57 , 58 The body's capacity to mount an immune response against viral infections can be hindered by these comorbidities, which can disrupt the immune system's normal function. 59 , 60 …”