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Observational Study
. 2020 Oct 16;20(1):409.
doi: 10.1186/s12877-020-01803-5.

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- a cohort study

Rajkumar Chinnadurai  1   2   3 , Onesi Ogedengbe  4 , Priya Agarwal  4 , Sally Money-Coomes  4 , Ahmad Z Abdurrahman  4 , Sajeel Mohammed  4 , Philip A Kalra  5   6 , Nicola Rothwell  4 , Sweta Pradhan  4
Affiliations
Observational Study

Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- a cohort study

Rajkumar Chinnadurai et al. BMC Geriatr. .

Abstract

Background: There is a need for more observational studies across different clinical settings to better understand the epidemiology of the novel COVID-19 infection. Evidence on clinical characteristics of COVID-19 infection is scarce in secondary care settings in Western populations.

Methods: We describe the clinical characteristics of all consecutive COVID-19 positive patients (n = 215) admitted to the acute medical unit at Fairfield General Hospital (secondary care setting) between 23 March 2020 and 30 April 2020 based on the outcome at discharge (group 1: alive or group 2: deceased). We investigated the risk factors that were associated with mortality using binary logistic regression analysis. Kaplan-Meir (KM) curves were generated by following the outcome in all patients until 12 May 2020.

Results: The median age of our cohort was 74 years with a predominance of Caucasians (87.4%) and males (62%). Of the 215 patients, 86 (40%) died. A higher proportion of patients who died were frail (group 2: 63 vs group 1: 37%, p < 0.001), with a higher prevalence of cardiovascular disease (group 2: 58 vs group 1: 33%, p < 0.001) and respiratory diseases (group 2: 38 vs group 1: 25%, p = 0.03). In the multivariate logistic regression models, older age (odds ratio (OR) 1.03; p = 0.03), frailty (OR 5.1; p < 0.001) and lower estimated glomerular filtration rate (eGFR) on admission (OR 0.98; p = 0.01) were significant predictors of inpatient mortality. KM curves showed a significantly shorter survival time in the frail older patients.

Conclusion: Older age and frailty are chief risk factors associated with mortality in COVID-19 patients hospitalised to an acute medical unit at secondary care level. A holistic approach by incorporating these factors is warranted in the management of patients with COVID-19 infection.

Keywords: COVID-19; Frailty; Mortality; Older age; Risk factors.

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Conflict of interest statement

No competing interest to declare.

Figures

Fig. 1
Fig. 1
Flowchart of patient recruitment to the study
Fig. 2
Fig. 2
Distribution of outcomes based on age groups (a) and clinical frailty scores (b)
Fig. 3
Fig. 3
Kaplan-Meier curves for mortality based on age category (a) and frailty status (b)
See this image and copyright information in PMC

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