J Gerontol A Biol Sci Med Sci . Beyond chronological age: Frailty and multimorbidity predict in-hospital mortality in patients with coronavirus disease 2019

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J Gerontol A Biol Sci Med Sci


. 2020 Nov 20;glaa291.
doi: 10.1093/gerona/glaa291. Online ahead of print.
Beyond chronological age: Frailty and multimorbidity predict in-hospital mortality in patients with coronavirus disease 2019


Alessandra Marengoni ^{1 2 3} , Alberto Zucchelli ⁴ , Davide Liborio Vetrano ^{3 5} , Andrea Armellini ² , Emanuele Botteri ² , Franco Nicosia ² , Giuseppe Romanelli ^{1 2} , Eva Andrea Beindorf ² , Paola Giansiracusa ² , Emirena Garrafa ⁶ , Luigi Ferrucci ⁷ , Laura Fratiglioni ³ , Roberto Bernabei ⁵ , Graziano Onder ⁸



Affiliations

• PMID: 33216846
• DOI: 10.1093/gerona/glaa291

Abstract

Background: We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age.
Methods: 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Pre-disease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 of these in the same patient. The hazard (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated.
Results: Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units and 42 died. Patients who died were older (81.0 vs. 65.2 years, p<0.001), more frequently multimorbid (97.6 vs. 52.8%; p<0.001) and more likely frail (37.5 vs. 4.1%; p<0.001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR=1.3; 95%CI=1.05-1.62) and in patients aged 70+ years (HR=1.29;95%CI=1.04-1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years.
Conclusions: Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.

Keywords: COVID-19; frailty; in-hospital mortality; multimorbidity.