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Beyond Chronological Age: Frailty and Multimorbidity Predict In-Hospital Mortality in Patients With Coronavirus
Alessandra Marengoni1,2,3, Alberto Zucchelli4, Davide Liborio Vetrano3,5
1Department of Clinical and Experimental Sciences, University of Brescia, Italy.
Insights
Frailty, not just age, predicts COVID-19 in-hospital death. The Clinical Frailty Scale (CFS) identifies high-risk patients, with multimorbidity significantly increasing mortality risk.
Area of Science:
- Geriatrics
- Infectious Diseases
- Public Health
Background:
- COVID-19 poses a significant mortality risk, particularly in older adults.
- Assessing predictors of in-hospital mortality beyond chronological age is crucial for patient management.
Purpose of the Study:
- To evaluate if frailty and multimorbidity predict in-hospital mortality in COVID-19 patients.
- To determine if these factors offer predictive value beyond chronological age.
Main Methods:
- A cohort of 165 COVID-19 patients admitted to an acute geriatric ward in Italy was analyzed.
- Frailty was assessed using the Clinical Frailty Scale (CFS); multimorbidity was defined as ≥2 co-occurring diseases.
- Hazard ratios (HR) for in-hospital mortality were calculated based on CFS score and disease count.
Main Results:
- Patients who died were older, more frequently multimorbid (97.6%), and more frail (37.5%).
- Each CFS increment increased in-hospital death risk (HR=1.3); multimorbidity alone increased risk to 28%, and with frailty to 75%.
- CFS improved mortality prediction by 9.4% in patients aged 70+ when added to age and sex.
Conclusions:
- Frailty independently identifies COVID-19 patients at risk of in-hospital death, irrespective of age.
- Multimorbidity significantly impacts prognosis, with very low mortality observed in its absence.
Background:
We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age.
Method:
A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 diseases in the same patient. The hazard ratio (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 < .001), more frequently multimorbid (97.6 vs 52.8%; p < .001), and more likely frail (37.5 vs 4.1%; p < .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.
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