Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study
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Publication date
2021-05-05
Authors
Blomaard, Laura C.
van der Linden, Carolien M.J.
van der Bol, Jessica M.
Jansen, Steffy W.M.
Polinder-Bos, Harmke A.
Willems, Hanna C.
Festen, Jan
Barten, Dennis G.
Borgers, Anke J.
Bos, Jeannet C.
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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
clinical frailty scale, COVID-19, frailty, older adults, SARS-CoV-2, Hospital Mortality, Humans, Male, Frailty/complications, COVID-19/mortality, Frail Elderly/statistics & numerical data, Aged, 80 and over, Pandemics/statistics & numerical data, Female, Hospitalization/statistics & numerical data, Aged, Retrospective Studies, Netherlands/epidemiology, Geriatrics and Gerontology, Ageing, Journal Article
Citation
Blomaard, L C, van der Linden, C M J, van der Bol, J M, Jansen, S W M, Polinder-Bos, H A, Willems, H C, Festen, J, Barten, D G, Borgers, A J, Bos, J C, van den Bos, F, de Brouwer, E J M, van Deudekom, F J A, van Dijk, S C, Emmelot-Vonk, M H, Geels, R E S, van de Glind, E M M, de Groot, B, Hempenius, L, Kamper, A M, Kampschreur, L M, de Koning, M M M, Labots, G, Looman, R, Lucke, J A, Maas, H A A M, Mattace-Raso, F U S, El Moussaoui, R, van Munster, B C, van Nieuwkoop, C, Oosterwijk, L B L E, Regtuijt, M E M, Robben, S H M, Ruiter, R, Salarbaks, A M, Schouten, H J, Smit, O M, Smits, R A L, Spies, P E, Vreeswijk, R, de Vries, O J, Wijngaarden, M A, Wyers, C E & Mooijaart, S P 2021, 'Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands : the COVID-OLD study', Age and ageing, vol. 50, no. 3, pp. 631-640. https://doi.org/10.1093/ageing/afab018