The association between frailty risk and COVID-19-associated all-mortality in hospitalised older people: a national cohort study

Maynou, Laia; Owen, Rhiannon K; Konstant-Hambling, Rob; Imam, Towhid; Arkill, Suzanne; Bertfield, Deborah; Street, Andrew; Abrams, Keith R.; Conroy, Simon

doi:10.1007/s41999-022-00668-8

Cited by 13 publications

(10 citation statements)

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“…In conclusion, the existing evidence about the association of an atypical presentation with mortality is conflicting, and our study adds to this evidence base. However, it is important that, as in our study, future studies correct for confounders, such as high age, male sex, frailty and higher CRP levels as these are associated with higher mortality in patients with COVID-19 [ 20 , 27 , 32 – 37 ]. In addition, we would recommend to investigate whether there is a difference in mortality between patients that present atypically but develop fever, cough or dyspnea later in their disease trajectory and those who do not develop any typical complaints.…”

Section: Discussionmentioning

confidence: 99%

Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes

et al. 2023

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Key Summary Points Aim To study the association between atypical presentation of COVID-19, frailty and adverse outcomes, as well as the incidence of atypical presentation. Findings In this study, an atypical presentation of COVID-19 was significantly associated with frailty. However, patients with an atypical presentation of COVID-19 did not have worse disease outcomes. Message Physicians need to remain alert for COVID-19 in frail older patients, as they may present without typical complaints. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-022-00736-z.

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Section: Discussionmentioning

confidence: 99%

Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes

et al. 2023

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“…Our study is one of very few to use machine learning techniques to explore the role of frailty and comorbidities in COVID-19 outcomes in hospitalized older adults, and by far the largest to date [ 37 ]. Measures such as the CFS and HFRS give a global measure of frailty but give little detail on the role of specific aspects of frailty and comorbidity in determining outcomes [ 38 ]. As such, their use in guiding decision-making has been questioned [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Frailty, Comorbidity, and Associations With In-Hospital Mortality in Older COVID-19 Patients: Exploratory Study of Administrative Data

Heyl¹,

Hardy²,

Tucker³

et al. 2022

Interact J Med Res

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Background Older adults have worse outcomes following hospitalization with COVID-19, but within this group there is substantial variation. Although frailty and comorbidity are key determinants of mortality, it is less clear which specific manifestations of frailty and comorbidity are associated with the worst outcomes. Objective We aimed to identify the key comorbidities and domains of frailty that were associated with in-hospital mortality in older patients with COVID-19 using models developed for machine learning algorithms. Methods This was a retrospective study that used the Hospital Episode Statistics administrative data set from March 1, 2020, to February 28, 2021, for hospitalized patients in England aged 65 years or older. The data set was split into separate training (70%), test (15%), and validation (15%) data sets during model development. Global frailty was assessed using the Hospital Frailty Risk Score (HFRS) and specific domains of frailty were identified using the Global Frailty Scale (GFS). Comorbidity was assessed using the Charlson Comorbidity Index (CCI). Additional features employed in the random forest algorithms included age, sex, deprivation, ethnicity, discharge month and year, geographical region, hospital trust, disease severity, and International Statistical Classification of Disease, 10th Edition codes recorded during the admission. Features were selected, preprocessed, and input into a series of random forest classification algorithms developed to identify factors strongly associated with in-hospital mortality. Two models were developed; the first model included the demographic, hospital-related, and disease-related items described above, as well as individual GFS domains and CCI items. The second model was similar to the first but replaced the GFS domains and CCI items with the HFRS as a global measure of frailty. Model performance was assessed using the area under the receiver operating characteristic (AUROC) curve and measures of model accuracy. Results In total, 215,831 patients were included. The model using the individual GFS domains and CCI items had an AUROC curve for in-hospital mortality of 90% and a predictive accuracy of 83%. The model using the HFRS had similar performance (AUROC curve 90%, predictive accuracy 82%). The most important frailty items in the GFS were dementia/delirium, falls/fractures, and pressure ulcers/weight loss. The most important comorbidity items in the CCI were cancer, heart failure, and renal disease. Conclusions The physical manifestations of frailty and comorbidity, particularly a history of cognitive impairment and falls, may be useful in identification of patients who need additional support during hospitalization with COVID-19.

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“…Patienten mit einem CFS-Score von 8 hatten im Vergleich gegenüber jenen Erkrankten mit CFS-Scores 1–3 ein 3fach höheres Risiko zu versterben [ 30 ]. Vergleichbare Daten über die Assoziation von Frailty und COVID-19-Sterblichkeit finden sich in mehreren Metaanalysen und Reviews [ 13 ]. Das mittel- und längerfristige Überleben (4 Wochen bis 8 Monate nach der Erkrankung) scheint mit dem Ausmaß der „Frailty“ kurz vor der Erkrankung und nicht mit dem Schweregrad von COVID-19 assoziiert zu sein [ 28 ].…”

Section: Frailty-syndromunclassified

„Coronavirus disease 2019“ und Frailty

Köller¹

2022

Z Gerontol Geriat

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Der Verlauf der Coronavirus disease 2019 (COVID-19) ist individuell sehr unterschiedlich. Menschen höheren Lebensalters mit Komorbiditäten sind gefährdeter, schwer zu erkranken oder zu versterben. Gebrechlichkeit (Frailty) ist ein wesentlicher Risikofaktor. Ein Fünftel der Bevölkerung in Mitteleuropa ist älter als 65 Jahre, 10–15 % davon sind als „frail“ anzusehen. Die Pandemie bringt die Gesundheitssysteme vieler Länder an deren Grenzen. Die Entscheidung, welche Patienten noch intensivmedizinisch behandelt werden, führt zu ethischen Diskussionen. Die Clinical Frailty Scale von Rockwood (CFS; CMAJ 173:489–495, 2005) wird in manchen Ländern eingesetzt, diese Entscheidungen zu unterstützen. Von COVID-19 betroffene 80-jährige Patienten haben ein fast 3,6faches Sterblichkeitsrisiko, verglichen mit der Altersgruppe von 18 bis 49 Jahren. Das Risiko gebrechlicher Patienten (CFS-Scores 6–9) ist mehr als 3fach höher als von robusten (CFS-Scores 1–3). Ein CFS-Cut-off-Wert ≥ 6 korreliert mit der Mortalität von COVID-19-Patienten über 65 Jahre. Das mittel- und längerfristige Überleben ist auch mit dem Ausmaß von „Frailty“ vor der Erkrankung und weniger mit dem Schweregrad der COVID-19 assoziiert. Besonders Patienten über 60 Jahre sind gefährdet, bei moderaten und schweren COVID-19-Verläufen rasch Muskelmasse zu verlieren. Patienten auf Intensive Care Units (ICU) verlieren innerhalb von 10 Tagen 20–30 % der Oberschenkelstreckmuskulaturmasse. Das Ausmaß der COVID-19-assoziierten Sarkopenie bestimmt wesentlich den Verlauf der Erkrankung und macht individuelle Rehabilitationsprogrammen erforderlich. Bis zu 50 % der hospitalisierten Patienten benötigen weitere Rehabilitation nach der Entlassung. Aerobes Training mit niedriger Intensität, kombiniert mit Krafttraining, sowie die Sicherstellung einer ausreichenden Energie- und Eiweißzufuhr sind unerlässlich.

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The association between frailty risk and COVID-19-associated all-mortality in hospitalised older people: a national cohort study

Cited by 13 publications

References 30 publications

Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes

Atypical presentation of COVID-19 in older patients is associated with frailty but not with adverse outcomes

Frailty, Comorbidity, and Associations With In-Hospital Mortality in Older COVID-19 Patients: Exploratory Study of Administrative Data

„Coronavirus disease 2019“ und Frailty

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