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

Marengoni A, Zucchelli A, Vetrano DL, Armellini A, Botteri E, Nicosia F, Romanelli G, Beindorf EA, Giansiracusa P, Garrafa E, Ferrucci L, Fratiglioni L, Bernabei R, Onder G

J Gerontol A Biol Sci Med Sci 76 (3) e38-e45 [2020-11-20; online 2020-11-20]

We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age. 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Pre-disease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 of these in the same patient. The hazard (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. 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<0.001), more frequently multimorbid (97.6 vs. 52.8%; p<0.001) and more likely frail (37.5 vs. 4.1%; p<0.001). 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. 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.

Category: Health

Type: Journal article

PubMed 33216846

DOI 10.1093/gerona/glaa291

Crossref 10.1093/gerona/glaa291

pii: 5996087

Publications 7.1.2