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. 2021 Jun 2;10(11):2472.
doi: 10.3390/jcm10112472.

Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection

Noemi R Simon  1 , Andrea S Jauslin  1 , Marco Rueegg  1 , Raphael Twerenbold  2 , Maurin Lampart  2 , Stefan Osswald  2 , Stefano Bassetti  3 , Sarah Tschudin-Sutter  4   5 , Martin Siegemund  5   6 , Christian H Nickel  1 , Roland Bingisser  1
Affiliations

Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection

Noemi R Simon et al. J Clin Med. .

Abstract

Older age and frailty are predictors of adverse outcomes in patients with COVID-19. In emergency medicine, patients do not present with the diagnosis, but with suspicion of COVID-19. The aim of this study was to assess the association of frailty and age with death or admission to intensive care in patients with suspected COVID-19. This single-centre prospective cohort study was performed in the Emergency Department of a tertiary care hospital. Patients, 65 years and older, with suspected COVID-19 presenting to the Emergency Department during the first wave of the pandemic were consecutively enrolled. All patients underwent nasopharyngeal SARS-CoV-2 PCR swab tests. Patients with a Clinical Frailty Scale (CFS) > 4, were considered to be frail. Associations between age, gender, frailty, and COVID-19 status with the composite adverse outcome of 30-day-intensive-care-admission and/or 30-day-mortality were tested. In the 372 patients analysed, the median age was 77 years, 154 (41.4%) were women, 44 (11.8%) were COVID-19-positive, and 125 (33.6%) were frail. The worst outcome was seen in frail COVID-19-patients with six (66.7%) adverse outcomes. Frailty (CFS > 4) and COVID-19-positivity were associated with an adverse outcome after adjustment for age and gender (frailty: OR 5.01, CI 2.56-10.17, p < 0.001; COVID-19: OR 3.47, CI 1.48-7.89, p = 0.003). Frailty was strongly associated with adverse outcomes and outperformed age as a predictor in emergency patients with suspected COVID-19.

Keywords: COVID-19; SARS-CoV-2; age; emergency department; frailty; intensive care; mortality.

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Conflict of interest statement

Twerenbold reports research support from the Swiss National Science Foundation (Grant No P300PB_167803), the Swiss Heart Foundation, the Swiss Society of Cardiology, the Cardiovascular Research Foundation Basel, the University of Basel and the University Hospital Basel. None of the other authors have any conflicts of interest to declare.

Figures

Figure A1
Figure A1
Distribution of CFS-levels in COVID-19 and non-COVID-19 patients.
Figure 1
Figure 1
Inclusion procedure of patients with suspected COVID-19 who presented to the ED.
Figure 2
Figure 2
Adverse outcomes by frailty status: Graphical description of adverse outcomes (30-day-mortality or 30-day-ICU-admission) based on Cox regression with frailty status as strata, adjusted for age and gender. Frailty-levels were collapsed to “frail” (CFS 5–9) and “non-frail” (CFS1–4). To improve readability, the graph was cropped to 0.5 on the y axis. (p < 0.001, p-value based on logistic regression).
Figure 3
Figure 3
Adverse outcomes by frailty and swab status: Graphical description of adverse outcomes (composite outcome of 30-day-mortality or 30-day-ICU-admission), based on a Cox regression with combined groups of COVID-19 and CFS-status as strata, adjusted for age and gender, within the first 30 days after ED-admission for all patients in each subgroup (COVID-19-positive and frail, COVID-19-negative and frail, COVID-19-positive and non-frail, and COVID-19-negative and non-frail; n = 372). Frailty-levels were collapsed to “frail” (CFS 5–9) and “non-frail” (CFS1–4). (p < 0.001, p-value based on logistic regression).
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