tetano
Editor, Senior Moderator
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[SUP] 1 2 3 [/SUP], Alberto Zucchelli[SUP] 4 [/SUP], Davide Liborio Vetrano[SUP] 3 5 [/SUP], Andrea Armellini[SUP] 2 [/SUP], Emanuele Botteri[SUP] 2 [/SUP], Franco Nicosia[SUP] 2 [/SUP], Giuseppe Romanelli[SUP] 1 2 [/SUP], Eva Andrea Beindorf[SUP] 2 [/SUP], Paola Giansiracusa[SUP] 2 [/SUP], Emirena Garrafa[SUP] 6 [/SUP], Luigi Ferrucci[SUP] 7 [/SUP], Laura Fratiglioni[SUP] 3 [/SUP], Roberto Bernabei[SUP] 5 [/SUP], Graziano Onder[SUP] 8 [/SUP]
Affiliations
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.
. 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[SUP] 1 2 3 [/SUP], Alberto Zucchelli[SUP] 4 [/SUP], Davide Liborio Vetrano[SUP] 3 5 [/SUP], Andrea Armellini[SUP] 2 [/SUP], Emanuele Botteri[SUP] 2 [/SUP], Franco Nicosia[SUP] 2 [/SUP], Giuseppe Romanelli[SUP] 1 2 [/SUP], Eva Andrea Beindorf[SUP] 2 [/SUP], Paola Giansiracusa[SUP] 2 [/SUP], Emirena Garrafa[SUP] 6 [/SUP], Luigi Ferrucci[SUP] 7 [/SUP], Laura Fratiglioni[SUP] 3 [/SUP], Roberto Bernabei[SUP] 5 [/SUP], Graziano Onder[SUP] 8 [/SUP]
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.