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. 2022 Oct 19;37(11):2264-2274.
doi: 10.1093/ndt/gfac246.

The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis

Pim Bouwmans  1   2 , Lloyd Brandts  3 , Luuk B Hilbrands  4 , Raphaël Duivenvoorden  4 , Priya Vart  5   6 , Casper F M Franssen  6 , Adrian Covic  7   8 , Mahmud Islam  9   10 , Clémentine Rabaté  10 , Kitty J Jager  11   12 , Marlies Noordzij  6 , Ron T Gansevoort  6 , Marc H Hemmelder  1   2 ; ERACODA collaborators
Collaborators, Affiliations

The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis

Pim Bouwmans et al. Nephrol Dial Transplant. .

Abstract

Background: Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (COVID-19) patients. This study evaluates the impact of CFS on intensive care unit (ICU) admission rate and hospital and ICU mortality rates in hospitalized dialysis patients with COVID-19.

Methods: We analysed data of dialysis patients diagnosed with COVID-19 from the European Renal Association COVID-19 Database. The primary outcome was ICU admission rate and secondary outcomes were hospital and ICU mortality until 3 months after COVID-19 diagnosis. Cox regression analyses were performed to assess associations between CFS and outcomes.

Results: A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7-9 and highest (27%) in patients 65-75 years of age with a CFS of 5. A CFS of 7-9 was associated with a lower ICU admission rate than a CFS of 1-3 [relative risk 0.49 (95% confidence interval 0.27-0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7-9 (69%). Only 9% of patients with a CFS ≥6 survived after ICU admission. After adjustment for age and sex, each CFS category ≥4 was associated with higher hospital and ICU mortality compared with a CFS of 1-3.

Conclusions: Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

Keywords: COVID-19; dialysis; frailty; intensive care units; mortality; triage.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1:
Figure 1:
Three-month mortality of hospitalized patients per age and CFS categories.
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