The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19 - 08/12/20
, Elif Hande Özcan Çetin, MD a, Uğur Canpolat, MD b, Sevgi Aras, MD c, Osman Celik, MD d, Naim Ata, MD d, Suayip Birinci, MD d, Serkan Çay, MD e, Özcan Özeke, MD e, Ibrahim Halil Tanboğa, MD, PhD f, g, Serkan Topaloğlu, MD e
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Highlights |
• | Hospital Frailty Risk Score used to assess the frailty in ≥65 patients with COVID-19 |
• | Frailty was associated with a higher risk of adverse outcomes for COVID-19 |
• | Frailty improved the prediction of adverse outcomes when added to comorbidities |
• | Identifying frailty can be addressed to reduce high-risk clinical outcomes |
Abstract |
Background |
Diagnosis and screening of frailty, a condition characterized by an increased vulnerability to adverse outcomes of COVID-19, has emerged as an essential clinical tool which is strongly recommended by healthcare providers concerned with hospitalized elderly population. The data showing the role of frailty in patients infected with COVID-19 is needed.
Methods |
This was a nationwide cohort study conducted at all hospitals in Turkey. All COVID-19 hospitalized patients (≥ 65 years) were included. Patients who were alive and not discharged up to July 20, 2020, were excluded. The frailty was assessed by using the “Hospital Frailty Risk Score” (HFRS). Patients were classified into three risk groups of frailty based on previously validated cut points as low (<5 points), intermediate (5-15 points), and high (>15 points). Additionally, patients who had the HFRS of ≥5 were defined as frail. The primary outcome was in-hospital mortality rates by frailty group.
Results |
Between March 11, 2020, and June 22, 2020, a total of 18,234 COVID-19 patients from all of 81 provinces of Turkey were included. Totally, 12,295 (67.4%) patients were defined as frail (HFRS of >5) of which 2,801 (15.4%) patients were categorized in the highest level of frailty (HFRS of >15). Observed in-hospital mortality rates were 697 (12.0%), 1,751 (18.2%) and 867 (31.0%) in low, intermediate and high hospital frailty risk, respectively (p<0.001). Compared with low HFRS (<5), the adjusted odds ratios for in-hospital mortality were 1.482 (1.334-1.646) for intermediate HFRS (5-15) and 2.084; 95% CI, 1.799-2.413 for high HFRS (>15).
Conclusions |
As a claims-based frailty model, the HFRS provides clinicians and health systems, a standardized tool for an effective detection and grading of frailty in patients in COVID-19. A frailty-based tailored management of the older population may provide a more accurate risk categorization for both therapeutic and preventive strategies.
Le texte complet de cet article est disponible en PDF.Keywords : COVID-19, Frailty
Plan
Vol 81 - N° 6
P. 944-951 - décembre 2020 Retour au numéro
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