TY - JOUR
T1 - Beyond chronological age
T2 - Frailty and multimorbidity predict in-hospital mortality in patients with coronavirus disease 2019
AU - Marengoni, Alessandra
AU - Zucchelli, Alberto
AU - Vetrano, Davide Liborio
AU - Armellini, Andrea
AU - Botteri, Emanuele
AU - Nicosia, Franco
AU - Romanelli, Giuseppe
AU - Beindorf, Eva Andrea
AU - Giansiracusa, Paola
AU - Garrafa, Emirena
AU - Ferrucci, Luigi
AU - Fratiglioni, Laura
AU - Bernabei, Roberto
AU - Onder, Graziano
N1 - Funding Information:
This work was supported in part by the Intramural Research Program of the National Institute on Aging, NIH, Baltimore, MD, USA
Publisher Copyright:
© 2020 The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.
PY - 2021/3/1
Y1 - 2021/3/1
N2 - Background: We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age. Method: A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 diseases in the same patient. The hazard ratio (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated. Results: Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units, and 42 died. Patients who died were older (81.0 vs 65.2 years, p <. 001), more frequently multimorbid (97.6 vs 52.8%; p <. 001), and more likely frail (37.5 vs 4.1%; p <. 001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only, and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR = 1.3; 95% CI = 1.05-1.62) and in patients aged 70+ years (HR = 1.29; 95% CI = 1.04-1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years. Conclusions: Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.
AB - Background: We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age. Method: A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 diseases in the same patient. The hazard ratio (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated. Results: Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units, and 42 died. Patients who died were older (81.0 vs 65.2 years, p <. 001), more frequently multimorbid (97.6 vs 52.8%; p <. 001), and more likely frail (37.5 vs 4.1%; p <. 001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only, and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR = 1.3; 95% CI = 1.05-1.62) and in patients aged 70+ years (HR = 1.29; 95% CI = 1.04-1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years. Conclusions: Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.
KW - Covid-19
KW - Frailty
KW - In-hospital mortality
KW - Multimorbidity
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U2 - 10.1093/gerona/glaa291
DO - 10.1093/gerona/glaa291
M3 - Article
C2 - 33216846
AN - SCOPUS:85102394625
SN - 1079-5006
VL - 76
SP - E38-E45
JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
IS - 3
ER -