Comparing associations between frailty and mortality in hospitalised older adults with or without COVID-19 infection: a retrospective observational study using electronic health records

Abstract

Background The aim of this study was to describe outcomes in hospitalised older people with different levels of frailty and COVID-19 infection. Methods We 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. Findings We 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) through 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. Interpretation In this study frailty, measured using the Clinical Frailty Scale, 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 seven-fold hazard for death.

Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people

“…To date, most studies are describing mortality without reference to a contemporaneous non-COVID-19 population, which would obscure the interaction apparent in our data. In this respect, our findings are most consistent with comparable data from Leicester which also show no association between frailty and mortality in COVID-19 [15].…”

The Clinical Frailty Scale: Estimating the Prevalence of Frailty in Older Patients Hospitalised with COVID-19. The COPE Study

“…The prevalence of frailty (CFS ≥ 5) in our study was high (66.9%), which was similar to recently published results from a cohort comparing non-COVID-19 older patients with COVID-19 patients [23]. These figures are high but unsurprising, given the unselected nature of our cohort who are hospitalised with COVID-19.…”

“…These values contrast with the prevalence of frailty in community-dwelling older people, where previous estimates have ranged from 9.9-13.6% (pooled estimates) [15], to 22.4% and 43.7% over the age of 65, and over the age of 85, respectively [16]. In a non-COVID-19 population, all-cause mortality in the severely frail was 33%, but was much higher in the COVID-19 group at 60% [23]. This implies that frailty is not the sole cause of mortality, rather a key factor for consideration, along with the acute illness [27].…”

Frailty and comorbidity in predicting community COVID-19 mortality in the UK Biobank: the effect of sampling

“…A growing number of studies have investigated the association between frailty, frequently measured using the CFS in hospital settings, and mortality among patients, but findings remain inconclusive. While there is evidence that frailty may add to the risk prediction in hospitalized patients [16][17][18][19], some studies have observed weak [20,21], or All rights reserved. No reuse allowed without permission.…”