The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis

Abstract

Background Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill COVID-19 patients. This study evaluates the impact of CFS on intensive care unit (ICU) admission rate, and hospital- and ICU mortality rates in hospitalized dialysis patients with COVID-19. Methods We analysed data of dialysis patients diagnosed with COVID-19 from the European Renal Association COVID-19 Database. The primary outcome was ICU admission rate and secondary outcomes were hospital- and ICU mortality until 3 months after COVID-19 diagnosis. Cox regression analyses were performed to assess associations between CFS and outcomes. Results 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. ICU admission rate was lowest (5%) in patients >75 years with CFS 7-9 and highest (27%) in patients 65-75 years with CFS 5. CFS 7-9 was associated with a lower ICU admission rate than CFS 1-3 (RR 0.49; 95%CI 0.27-0.87). Overall, mortality at three months was 34% in hospitalized patients, 65% in ICU admitted patients and highest in patients >75 years with CFS 7-9 (69%). Only 9% of patients with CFS ≥6 survived after ICU admission. After adjustment for age and sex, each CFS category ≥4 was associated with higher hospital and ICU mortality compared with CFS 1-3. Conclusions Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

Risk factors for mortality and antibody responses in chronic hemodialysis patients with coronavirus disease 2019: a single-center experience in China

“…This study demonstrated that higher clinical frailty scores were associated with higher mortality in dialysis patients with COVID-19. This indicates that an easy-to-use clinical frailty score such as the CFS should be used to guide treatment decisions in dialysis patients with COVID-19 (22). Therefore, strategies aimed at preventing or attenuating frailty in the dialysis population are warranted (21).…”

COVID-19 and cardiovascular disease in patients with chronic kidney disease

“…Because of their high burden of comorbidities and/or advanced age, patients with advanced CKD are often not qualified for intensive care and mechanical ventilation, further reducing their probability of survival in case of severe respiratory insufficiency. However, the outcome is poor also for those entering the intensive care unit (ICU), with only 1 in 10 surviving [ 8 ].…”

Multi-omics and immune cells’ profiling of COVID-19 patients for ICU admission prediction: in silico analysis and an integrated machine learning-based approach in the framework of Predictive, Preventive, and Personalized Medicine

“…Severe cases should be admitted to the intensive care unit (ICU) and undergo mechanical ventilation (MV) with a higher mortality rate [ 4 ]. The intensive care unit admissions (ICUA) criteria of COVID-19 patients is still controversial and remain poorly defined under the paradigm of reactive medicine [ 5 – 7 ]. According to current criteria, approximately 5 to 32% of COVID-19 patients are admitted to an ICU, which has caused a huge burden to ICU beds [ 8 , 9 ].…”