The Value of Clinical Frailty Scale (CFS) as a Prognostic Tool in Predicting Mortality in COVID-19—A Retrospective Cohort Study

Abstract

Background: Due to the unpredictable nature of COVID-19, there is a need to identify patients at high risk of severe course of the disease and a higher mortality rate. Objective: This study aims to find the correlation between frailty and mortality in adult, hospitalized patients with COVID-19. Methods: Clinical records of 201 patients who suffered from COVID-19 and were hospitalized between October 2020 and February 2021 were retrospectively analyzed. Demographic, clinical, and biochemical data were collected. Patients were assessed using Clinical Frailty Scale (CFS) and were divided into three groups: CFS 1–3 fit; CFS 4–6 vulnerable and with mild to moderate frailty; CSF 7–9, severe frailty. The association between frailty and in-hospital mortality was the primary outcome. Results: Severe frailty or terminal illness was observed in 26 patients (12.94%) from a cohort of 201 patients. Those patients were older (median age 80.73, p < 0.001) and had more comorbidities. Frailty was also associated with higher requirement for oxygen supplementation, greater risk of in-hospital complications and worse biochemical laboratory results. An increase in CFS score also correlated with higher mortality (OR = 1.727, p < 0.001). The Conclusions: Clinical Frailty Scale (CFS) can be used as a potentially useful tool in predicting mortality in patients with COVID-19.

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

“…Myalgia-arthralgia was less common in frail patients in multivariable analysis, contradicting other results showing no association [ 24 ]. Anosmia-dysgeusia was likewise less common in frail patients, independently of other variables.…”

“…Typical features of COVID-19, like fever and cough, were less prevalent in frail older patients, as reported elsewhere [ 15 , 23 ], although in our multivariable analysis fever did not show significant, independent differences according to frailty. Dry cough presented less frequently in frail patients, as reported by Poco et al [ 15 ] and Jachymek et al, [ 24 ] and this difference was significant after adjusting for confounders. However, our results contrast with other studies showing that this symptom is more common in older, frail patients with COVID-19 [ 15 , 23 , 25 ]…”

“…Dry cough presented less frequently in frail patients, as reported by Poco et al [15] and Jachymek et al, [24] and this difference was significant after adjusting for confounders. However, our results contrast with other studies showing that this symptom is more common in older, frail patients with COVID-19 [15,23,25] Myalgia-arthralgia was less common in frail patients in multivariable analysis, contradicting other results showing no association [24]. Anosmia-dysgeusia was likewise less common in frail patients, independently [23] The reduced presence of this symptom in frail patients has been described in fewer studies [24].…”

“…The scant literature on the topic suggests that frailty is associated with atypical clinical presentation in infectious disease [ 15 , 23 , 24 ]. Typical features of COVID-19, like fever and cough, were less prevalent in frail older patients, as reported elsewhere [ 15 , 23 ], although in our multivariable analysis fever did not show significant, independent differences according to frailty.…”

“…It is well known that the prevalence of anosmia-dysgeusia decreases with the age of infected patients, as von Bartheld et al concluded from their meta-analysis. [ 23 ] The reduced presence of this symptom in frail patients has been described in fewer studies [ 24 ].…”