Premium
COVID ‐19 is not over and age is not enough: Using frailty for prognostication in hospitalized patients
Author(s) -
Aliberti Márlon Juliano Romero,
Szlejf Claudia,
AvelinoSilva Vivian I.,
Suemoto Claudia Kimie,
Apolinario Daniel,
Dias Murilo Bacchini,
Garcez Flavia Barreto,
Trindade Carolina B.,
Amaral José Renato das Graças,
Melo Leonardo Rabelo,
Aguiar Renata Cunha,
Coelho Paulo Henrique Lazzaris,
Hojaij Naira Hossepian Salles de Lima,
Saraiva Marcos Daniel,
Silva Natalia Oliveira Trajano,
JacobFilho Wilson,
AvelinoSilva Thiago J.
Publication year - 2021
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.17146
Subject(s) - medicine , hazard ratio , confidence interval , observational study , proportional hazards model , covid-19 , cohort study , cohort , frailty index , emergency medicine , disease , infectious disease (medical specialty)
Background Frailty screening using the Clinical Frailty Scale (CFS) has been proposed to guide resource allocation in acute care settings during the pandemic. However, the association between frailty and coronavirus disease 2019 (COVID‐19) prognosis remains unclear. Objectives To investigate the association between frailty and mortality over 6 months in middle‐aged and older patients hospitalized with COVID‐19 and the association between acute morbidity severity and mortality across frailty strata. Design Observational cohort study. Setting Large academic medical center in Brazil. Participants A total of 1830 patients aged ≥50 years hospitalized with COVID‐19 (March–July 2020). Measurements We screened baseline frailty using the CFS (1–9) and classified patients as fit to managing well (1–3), vulnerable (4), mildly (5), moderately (6), or severely frail to terminally ill (7–9). We also computed a frailty index (0–1; frail >0.25), a well‐known frailty measure. We used Cox proportional hazards models to estimate the association between frailty and time to death within 30 days and 6 months of admission. We also examined whether frailty identified different mortality risk levels within strata of similar age and acute morbidity as measured by the Sequential Organ Failure Assessment (SOFA) score. Results Median age was 66 years, 58% were male, and 27% were frail to some degree. Compared with fit‐to‐managing‐well patients, the adjusted hazard ratios (95% confidence interval [CI]) for 30‐day and 6‐month mortality were, respectively, 1.4 (1.1–1.7) and 1.4 (1.1–1.7) for vulnerable patients; 1.5 (1.1–1.9) and 1.5 (1.1–1.8) for mild frailty; 1.8 (1.4–2.3) and 1.9 (1.5–2.4) for moderate frailty; and 2.1 (1.6–2.7) and 2.3 (1.8–2.9) for severe frailty to terminally ill. The CFS achieved outstanding accuracy to identify frailty compared with the Frailty Index (area under the curve = 0.94; 95% CI = 0.93–0.95) and predicted different mortality risks within age and acute morbidity groups. Conclusions Our results encourage the use of frailty, alongside measures of acute morbidity, to guide clinicians in prognostication and resource allocation in hospitalized patients with COVID‐19.