Paola Rebora1, Emanuele Focà2,3, Andrea Salvatori1, Alberto Zucchelli4, Isabella Ceravolo5, Alice M Ornago5, Alberto Finazzi5, Stefania Arsuffi2, Paolo Bonfanti5,6, Giuseppe Citerio5, Paolo Mazzola5,7, Fiona Ecarnot8, Maria G Valsecchi1, Alessandra Marengoni9, Giuseppe Bellelli10,7. 1. School of Medicine and Surgery, Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, University of Milano-Bicocca, Monza, Monza-Brianza, Italy. 2. Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 3. Spedali Civili Hospital, Brescia, Italy. 4. Department of Information Engineering, University of Brescia, Brescia, Italy. 5. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy. 6. Unit of Infectious Diseases, San Gerardo Hospital, Monza, Monza-Brianza, Italy. 7. Unit of Acute Geriatrics, San Gerardo Hospital, Monza, Monza-Brianza, Italy. 8. Department of Cardiology, EA3920, University Hospital of Besançon, University of Franche-Comté, Besançon, France. 9. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 10. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Monza-Brianza, Italy - giuseppe.bellelli@unimib.it.
Abstract
BACKGROUND: Older people hospitalized for COVID-19 are at highest risk of death. Frailty Assessment can detect heterogeneity in risk among people of the same chronological age. We investigated the association between frailty and in-hospital and medium-term mortality in middle-aged and older adults with COVID-19 during the first two pandemic waves. METHODS: This study is an observational multicenter study. We recorded sociodemographic factors (age, sex), smoking status, date of symptom onset, biological data, need for supplemental oxygen, comorbidities, cognitive and functional status, in-hospital mortality. We calculated a Frailty Index (FI) as the ratio between deficits presented and total deficits considered for each patient (theoretical range 0-1). We also assessed the Clinical Frailty Scale (CFS). Mortality at follow-up was ascertained from a regional registry. RESULTS: In total, 1344 patients were included; median age 68 years (Q1-Q3, 56-79); 857 (64%) were men. Median CFS score was 3 (Q1-Q3 2-5) and was lower in younger vs. older patients. Median FI was 0.06 (Q1-Q3 0.03-0.09) and increased with increasing age. Overall, 244 (18%) patients died in-hospital and 288 (22%) over a median follow-up of 253 days. FI and CFS were significantly associated with risk of death. In two different models using the same covariates, each increment of 0.1 in FI increased the overall hazard of death by 35% (HR=1.35, 95%CI 1.23-1.48), similar to the hazard for each increment of CFS (HR=1.37, 95%CI 1.25-1.50). CONCLUSIONS: Frailty, assessed with the FI or CFS, predicts in-hospital and medium-term mortality and may help estimate vulnerability in middle-aged and older COVID-19 patients.
BACKGROUND: Older people hospitalized for COVID-19 are at highest risk of death. Frailty Assessment can detect heterogeneity in risk among people of the same chronological age. We investigated the association between frailty and in-hospital and medium-term mortality in middle-aged and older adults with COVID-19 during the first two pandemic waves. METHODS: This study is an observational multicenter study. We recorded sociodemographic factors (age, sex), smoking status, date of symptom onset, biological data, need for supplemental oxygen, comorbidities, cognitive and functional status, in-hospital mortality. We calculated a Frailty Index (FI) as the ratio between deficits presented and total deficits considered for each patient (theoretical range 0-1). We also assessed the Clinical Frailty Scale (CFS). Mortality at follow-up was ascertained from a regional registry. RESULTS: In total, 1344 patients were included; median age 68 years (Q1-Q3, 56-79); 857 (64%) were men. Median CFS score was 3 (Q1-Q3 2-5) and was lower in younger vs. older patients. Median FI was 0.06 (Q1-Q3 0.03-0.09) and increased with increasing age. Overall, 244 (18%) patients died in-hospital and 288 (22%) over a median follow-up of 253 days. FI and CFS were significantly associated with risk of death. In two different models using the same covariates, each increment of 0.1 in FI increased the overall hazard of death by 35% (HR=1.35, 95%CI 1.23-1.48), similar to the hazard for each increment of CFS (HR=1.37, 95%CI 1.25-1.50). CONCLUSIONS: Frailty, assessed with the FI or CFS, predicts in-hospital and medium-term mortality and may help estimate vulnerability in middle-aged and older COVID-19 patients.