Beyond chronological age: Frailty and multimorbidity predict in-hospital mortality in patients with coronavirus disease 2019

Alessandra Marengoni, Alberto Zucchelli, Davide Liborio Vetrano, Andrea Armellini, Emanuele Botteri, Franco Nicosia, Giuseppe Romanelli, Eva Andrea Beindorf, Paola Giansiracusa, Emirena Garrafa, Luigi Ferrucci, Laura Fratiglioni, Roberto Bernabei, Graziano Onder

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)E38-E45
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Issue number3
Publication statusPublished - Mar 1 2021


  • Covid-19
  • Frailty
  • In-hospital mortality
  • Multimorbidity

ASJC Scopus subject areas

  • Ageing
  • Geriatrics and Gerontology


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