Frailty and Mortality in Hospitalized Older Adults With COVID-19: Retrospective Observational Study

Abstract

Objectives: To determine the association between frailty and short-term mortality in older adults hospitalized for coronavirus disease 2019 (COVID-19).

Design: Retrospective single-center observational study.

Setting and participants: Eighty-one patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of a general hospital in Belgium.

Measurements: Frailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical, and radiologic variables, comorbidities, symptoms, and treatment were extracted from electronic medical records.

Results: Participants (N = 48 women, 59%) had a median age of 85 years (range 65-97 years) and a median CFS score of 7 (range 2-9); 42 (52%) were long-term care residents. Within 6 weeks, 18 patients died. Mortality was significantly but weakly associated with age (Spearman r = 0.241, P = .03) and CFS score (r = 0.282, P = .011), baseline lactate dehydrogenase (LDH; r = 0.301, P = .009), lymphocyte count (r = -0.262, P = .02), and RT-PCR cycle threshold (Ct, r = -0.285, P = .015). Mortality was not associated with long-term care residence, dementia, delirium, or polypharmacy. In multivariable logistic regression analyses, CFS, LDH, and RT-PCR Ct (but not age) remained independently associated with mortality. Both age and frailty had poor specificity to predict survival. A multivariable model combining age, CFS, LDH, and viral load significantly predicted survival.

Conclusions and implications: Although their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available.

Keywords: COVID-19; frailty; hospitalization; older adults; severe acute respiratory syndrome coronavirus 2.

Figure 1

(A) Receiver operating characteristic curves for model with age + clinical frailty score (CFS). (B) Receiver operating characteristic curve for model including age, CFS, reverse-transcriptase polymerase chain reaction cycling threshold (RT-PCR Ct values), and lactate dehydrogenase (LDH) levels.

Supplementary Figure 1

(A) Visual outline showing survivors and nonsurvivors according to their age and clinical frailty score. (B) Kaplan-Meier curves for frail vs nonfrail individuals. Logistic plots showing probability of death from COVID-19 according to baseline (C) age, (D) CFS, (E) reverse transcriptase polymerase chain reaction cycling threshold (RT-PCR Ct) values, or (F) lactate dehydrogenase (LDH) plasma concentration in single-factor logistic regression models.