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. 2021 May 5;50(3):631-640.
doi: 10.1093/ageing/afab018.

Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

Laura C Blomaard  1 , Carolien M J van der Linden  2 , Jessica M van der Bol  3 , Steffy W M Jansen  2 , Harmke A Polinder-Bos  4 , Hanna C Willems  5 , Jan Festen  6 , Dennis G Barten  7 , Anke J Borgers  8 , Jeannet C Bos  9 , Frederiek van den Bos  10 , Esther J M de Brouwer  8 , Floor J A van Deudekom  11 , Suzanne C van Dijk  12 , Mariëlle H Emmelot-Vonk  10 , Raya E S Geels  1   13 , Esther M M van de Glind  13 , Bas de Groot  14 , Liesbeth Hempenius  15 , Ad M Kamper  16 , Linda M Kampschreur  17 , Marre M M de Koning  12 , Geert Labots  18 , Roy Looman  19 , Jacinta A Lucke  20 , Huub A A M Maas  21 , Francesco U S Mattace-Raso  4 , Rachida El Moussaoui  22 , Barbara C van Munster  23 , Cees van Nieuwkoop  18 , Leanne B L E Oosterwijk  4 , Marlies E M Regtuijt  24 , Sarah H M Robben  21 , Rikje Ruiter  22   25 , Aisha M Salarbaks  24 , Henrike J Schouten  26 , Orla M Smit  19 , Rosalinde A L Smits  1 , Petra E Spies  26 , Ralph Vreeswijk  27 , Oscar J de Vries  11 , Marjolein A Wijngaarden  1 , Caroline E Wyers  28 , Simon P Mooijaart  1
Affiliations

Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

Laura C Blomaard et al. Age Ageing. .

Abstract

Background: During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, older patients had an increased risk of hospitalisation and death. Reports on the association of frailty with poor outcome have been conflicting.

Objective: The aim of the present study was to investigate the independent association between frailty and in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands.

Methods: This was a multicentre retrospective cohort study in 15 hospitals in the Netherlands, including all patients aged ≥70 years, who were hospitalised with clinically confirmed COVID-19 between February and May 2020. Data were collected on demographics, co-morbidity, disease severity and Clinical Frailty Scale (CFS). Primary outcome was in-hospital mortality.

Results: A total of 1,376 patients were included (median age 78 years (interquartile range 74-84), 60% male). In total, 499 (38%) patients died during hospital admission. Parameters indicating presence of frailty (CFS 6-9) were associated with more co-morbidities, shorter symptom duration upon presentation (median 4 versus 7 days), lower oxygen demand and lower levels of C-reactive protein. In multivariable analyses, the CFS was independently associated with in-hospital mortality: compared with patients with CFS 1-3, patients with CFS 4-5 had a two times higher risk (odds ratio (OR) 2.0 (95% confidence interval (CI) 1.3-3.0)) and patients with CFS 6-9 had a three times higher risk of in-hospital mortality (OR 2.8 (95% CI 1.8-4.3)).

Conclusions: The in-hospital mortality of older hospitalised COVID-19 patients in the Netherlands was 38%. Frailty was independently associated with higher in-hospital mortality, even though COVID-19 patients with frailty presented earlier to the hospital with less severe symptoms.

Keywords: COVID-19; SARS-CoV-2; clinical frailty scale; frailty; older adults.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flowchart of study population.
See this image and copyright information in PMC

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