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

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.

Frailty assessment in emergency medicine using the Clinical Frailty Scale: a scoping review

“…Table 1 presents characteristics of the included studies. All studies were published in English and the primary author affiliation was mainly from North America [7,[30][31][32][33][34][35][36][37][38][39][40][41][42][43] (44%) and Europe [44][45][46][47][48][49][50][51][52][53][54][55] (35%). No papers had been published before 2015, and most of the papers (76%) were published beginning 2019.…”

“…No papers had been published before 2015, and most of the papers (76%) were published beginning 2019. Studies were published in emergency medicine journals (41%) [7, 30, 32, 33, 36, 40, 46, 48-50, 53, 54, 56, 57], geriatric journals (38%) [31,34,35,38,39,41,42,45,47,56,58,59] or other types of journals (21%) [37,43,51,52,55,60,61]. Two-thirds of the studies were prospective cohorts [7, 30, 33, 35-38, 40, 42, 43, 47-50, 52, 54-59, 62], while the remaining were retrospective cohorts (24%) [34,39,41,45,46,53,60,61], intervention studies (9%) [31,44,51] or cross-sectional studies (3%) [32] (Table 1).…”

“…When CFS was used as a main exposure or a predictor (20 studies), the most frequent studied outcomes (either alone or in composite) were mortality (10 studies, 50%) [33, 39, 46, 49, 55-58, 60, 62] and hospital admission (7 studies, 35%) (Table 3) [33,35,41,49,53,55,60]. For mortality, several time points were used, including 1 month [33,39,49,55,57,60], 3 months [56,62] or 1 year. Three papers used it as a time-to-event variable [39,46,49].…”

The clinical frailty scale predicts 1‐year mortality in emergency department patients aged 65 years and older

“…Other studies did find that frailty was associated with adverse outcomes in COVID-19 that worsened with increasing frailty. 42,47 To our surprise, we found separation on the survival plot for CFS level 8 compared to lower levels. A CFS of 7 or above has F I G U R E 1 The chart displays recruitment and follow-up procedure of consecutive ED patients aged 65 and older been considered a range that indicated futility of resuscitation attempts previously, and subjects with CFS levels 6 to 9 have been grouped when examining outcomes after cardiopulmonary resuscitation.…”

“…However, these findings are likely biased by selection as they are restricted to patients who were ultimately admitted after their initial evaluation in the ED and at least 65 years old. Other studies did find that frailty was associated with adverse outcomes in COVID‐19 that worsened with increasing frailty 42,47 …”