INTRODUCTION: Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear.METHODS: This multi-centre cohort study involved patients aged 18years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables.RESULTS: Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18-49: HR 3.57, CI 2.54-5.02), frailty (CFS 8 vs 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1-3: OR 7.00, CI 5.27-9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9.CONCLUSIONS: Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.
Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study / Welch, Carly; Wilson, Daisy; Mccluskey, Lauren; Richardson, Sarah; Ni Lochlainn, Mary; K Burton, Jenni; A Jackson, Thomas; Nirantharakumar, Krishnarajah; Pinkney, Thomas; Magill, Laura; Witham, Miles; Steves, Claire; Gordon, Adam; Quinn, Terence; Okoth, Kelvin; Perry, Rita; Pettitt, Michala; Hughes, Terry; Elhadi, Muhammed; Brown, Bryony; Hale, Matthew; Jelley, Benjamin; Gaunt, Victoria; Dani, Melanie; Soo, Chee; Sleeman, Isobel; Alsahab, Mustafa; Patterson, Katherine; Pigott, Jennifer; Seed, Adam; Torsney, Kelli; Masoli, Jane; Burn, Elinor; Beishon, Lucy; Taylor, Joanne; Cox, Natalie; Goujon, Marie; Freshwater, Sarah; Masud, Tahir; ME Pearson, Grace; Mcneela, Natalie; Reynolds, Abigail; Khan, Asma; Khiroya, Heena; Madden, Katy; Sanyal, Nik; Mohammedseid-Nurhussien, Awolkhier; Moorey, Hannah; N Osuafor, Christopher; David Strain, W; Lal, Rajni; A Abdelwahab, Omar; M Awad, Elsayed; Y Azzam, Ahmed; EB Masood, Almontacer; MAS Abdulhadi, Osama; Ahmed, Hazem; KM Hadreiez, Ahmed; A Momen, Ahmed; AA Shaban, Mosab; S Abd Elazeem, Hossam Aldein; H Abdelhafez, Mohammed; A Ahmed, Islam; M Elghazaly, Shrouk; F Hetta, Helal; Eltaher AA Ibrahim, Mohamed; M Mohamed, Soha; AR Mohamed Hussein, Aliae; M Moustafa, Mohamed; Albatoul Nageh, Mariam; M Saad, Mahmoud; M Saad, Alshaimaa; Zein Elabedeen, Omar; Cox, Victoria; Hunsley, Danielle; Ryall, Rebecca; T Shakespeare, Kathleen; Thyn, Thyn; Webb, Rachael; Hari Madhavan, Deepthy; Babar, Laxmi; Doll, Tina; Felska, Agnieszka; N Guerero, Daniel; Karthikeyan, Sandeep; Karunatilleke, Anne; Lee, Helena; Livesey, Emma; Roberts, Amelia; Roberts-Rhodes, Charlotte; Cordie, Ahmed; O Elmehrath, Ahmed; El-Shazly, Mostafa; Perra, Teresa; Porcu, Alberto; Buondonno, Antonio; Cecere, Giuseppe; Rocca, Aldo; Hogan, Vesna; Wilkinson, Iain; Baloyiannis, Ioannis; Hajiioannou, Jiannis; Perivoliotis, Konstantinos; Tzovaras, George; Fleck, Anna; Mcgovern, Aine; Babb, Laura; Bailey, Emily; Darley, Jay; M Draghita, Ioan; Hickman, Alexander; Kalloo, Jason; Kanzaria, Akhil; Nawaz, Wasim; Sadiq, Ambreen; Cardoso, Rifa; Faulkner, Margherita; Hurst, William; James, Ellen; Leadbetter, Aimee; Mayer, Jordan; Robinson, Tanya; Stratton, Emma; Thake, Miriam; Thould, Hannah; Watson, Hannah; Del Valle-Ruiz, Sergio; Martínez-Sanz, Nuria; Carrasco-Prats, Milagros; V Fernández- Fernández, Pedro; Giménez-Francés, Clara; Medina-Manuel, Esther; Ruiz-Marín, Miguel; López-Morales, Pedro; Pastor-Pérez, Patricia; Valero-Soriano, María; Mora-Guzmán, Ismael; Barra, Fabio; Ferraiolo, Antonella; Ferrero, Simone; Gustavino, Claudio; Kratochwila, Chiara; W Etchill, Eric; Gabre-Kidan, Alodia; H Gray, Joshua; R Haut, Elliott; Malapati, Harsha; F Rapaport, Sarah; A Stevens, Kent; Vervoort, Dominique; A Azab, Mohammed; Bryant, Catherine; Cheney-Lowe, Hannah; Cox, Catrin; Crowe, Andrew; Dick, Gordon; Evans, Sarah; CP Hogan, Patrick; Yee Law, Kar; Richardson, Alexandra; Speranza, Fabio; Toppley, Kathryn; Whitney, Julie; Yeung, Eirene; Charalabopoulos, Alexandros; Davakis, Spyridon; Karapanou, Amalia; Liakakos, Theodore; Baili, Efstratia; Mpoura, Maria; A Sampanis, Michail; V Sipsas, Nikolaos; Beishon, Lucy; Burn, Elinor; Doddamani, Parveen; Haunton, Victoria; Kabir, Shahriar; Shaw, Hannah; Warner, Chloe; K NasrEldin, Yasmin; AA Ghannam, Nourhan; Belgamwar, Ravindra; Bentley, Corrina; Aujayeb, Avinash; Dew, Lindsey; Dotchin, Catherine; M Dundas, James; Edwards, Elinor; F Gilbert, Georgia; Jackson, Karl; H Manning, Sarah; Maxfield, Dominic; Moss, Nicholas; C Murphy, Declan; Tullo, Ellen; H Welsh, Sarah; Buondonno, Antonio; Pinotti, Enrico; Alessandri, Francesco; Brachini, Gioia; Ceccarelli, Giancarlo; Ciccarone, Flavia; M Cicerchia, Pierfranco; Cirillo, Bruno; De Toma, Giorgio; Duranti, Giulia; Fiori, Enrico; B Fonsi, Giovanni; Lapolla, Pierfrancesco; Meneghini, Simona; Mingoli, Andrea; Pugliese, Francesco; Sapienza, Paolo; Simonelli, Luigi; Zambon, Martina; Cattel, Caterina; Guzman, Laurenny; Dowell, Hannah; Ibukunoluwakitan, Aina; Mohamed, Fawsiya; Spice, Claire; Stafford, Amanda; Atia, Jolene; Atkin, Catherine; Currie, Hannah; Evison, Felicity; Majid, Zeinab; Qurashi, Maria; Coulter, Siobhan; Mcdonald, Claire; Muir, Georgina; O'Mahony, Catherine; Tait, Caroline; Davies, Rowan; Honney, Katie; Winter, Laura; Adewole, Olubayode; Abdelmalak, Amir; Ahmad, Mohammed; H Ansari, Muhammed; Appiah, Kingsley; Dwivedi, Rajesh; Elrick, Hope; Ghobrial, Hedra; Jackson, Rosie; Jeffs, Sophie; Jeyakumar, Sasha; Lunt, Eleanor; Muzammil, Bushra; Pytraczyk, Sylvia; Sheldrake, Jonathan; Smith, Jennifer; Tobiss, Hannah; Vettasseri, Mark; H Willott, Ruth; Zaw, Hein; Bannerjee, Moulinath; Cummings, Jean; Hart, Barbara; Maughan, Tom; Baguneid, Clare; Budd, Gabrielle; Moriarty, Lizzie; Odutola, Omoteniola; Street, Hannah; Carr, Alexis; Baldwin, Sarah; Bashir, Hannah; Gibbon, Jake; Gray, Amy; Lewis, Grace; Page, Christina; Varden, Rosanna; Grubb, Anthony; Holmes, Elizabeth; Kainth, Harjinder; Reilly, Lara; Whitsey, Mark; Akcay, Mertcan; Akdeniz, Yeşim; Akın, Emrah; Altintoprak, Fatih; Bayhan, Zülfü; Capoglu, Recayi; Demir, Hakan; Firat, Necattin; Gonullu, Emre; Harmantepe, Tarık; Mantoglu, Baris; Muhtaroglu, Ali; Yigit, Merve; A Yildiz, Yasin; Al-Sodani, Lobna; Burden, Nicole; Charsley, Evelyn; Kneen, Thomas; Price, Angeline; Swinnerton, Emma; J Bo, Yen Nee; R Boden, Hayley; Bulla, Reem; Eastaugh, Alison; Lee, Helena; Mubin, Mohammed; Roberts, Amelia; Umeadi, Anthony; Wallis, Stephanie; Williamson, Megan; Lelt Win, Yu; A Ahmed, Eltayeb; Aljafari, Abdulmoiz; Aljafari, Abdulmalek; Mohammad, Abdulkader; Ali, Ali; Amini, Sylvia; Belcher, James; Giles, Marie; Jarvis, Hayley; Jenko, Nathan; Madan, Suvira; Noar, Alexander; Nwolu, Favour; Parkin, Jessica; C Passby, Lauren; Sivam, Jarita; Surtees, Michael; Wagland, Joanne; West, Ruth; Williams, David; Badh, Manpreet; Birchenough, Amy; Coulthard, Nick; Devaney, Alice; Gandhi, Ratnam; Hood, Katharine; North, Samuel; Pinkney, Martha; Shaw, Ellie; Whelan, Elisha; Dogra, Gurinder; Morris, Claire; Wright, Rebecca; Lim, Stephen; Orlando, Lia; Patel, Harnish; Puri, Prabhleen; Yang Sim, Sing; Akladious, Carolyn; Amaratungaz, Gitanjali; Amir, Taha; Anandarajah, Cheran; Anders, Rachael; Aziz, Sally; Barnard, Anna; Bawor, Monica; Bremner, Laura; Bridgwater, Hannah; Butt, Hejab; Caracostea, Andra; Chevallier, Theodore; Comerford, Victoria; Cullen, Jack; Cunningham, Niamh; Curley, Daniel; Daly, Madeleine; Dattani, Nikhita; Deldar, Benyamin; Desai, Arjun; Desai, Nirali; Dhesi, Jugdeep; Dias, Maria; C Dooley, Hannah; Dost, Samiullah; Dusara, Hiren; Emery, Alexander; Fairhead, Cassandra; Fernandez, Antia; Fisk, Gracie; Garner, Madeleine; Gerretsen, Hannah; Ghobrial, Andrew; Ghufoor, Zaynub; Green, Deirdre; Greene, Charlotte; Griffith, Karla; Gupta, Ayushi; Harrison, Patrick; Haslam, Aidan; Heinsohn, Torben; Hennah, Lindsay; Hobill, Abigail; Hopkinson, Katherine; Howells, Lara; Hrouda, Nicole; 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Amer, Jocelyn; Lyon, Emily; Sen, Michael; Al-Sadawi, Mohammed; Budzikoski, Adam; Ibtida, Ishmam; Qaiser, Yusra; T Azam, Mohammad; J Choudhry, Asad; Marx, William; Bouhuwaish, Ahmad; SA Taher, Ahmed; Georgiou, Nikolaos; Man, Jade; Reynolds, Paul; To, Benjaman; D Collins, Fatma; Budd, Sharon; Griffin, Ellanna; Guan, Yue; Hanji, Deevia; Lowes, Lily; Moomo, Farhana; Ogochukwu, Olebu; Thin, Katie; De Paola, Gilda; Gallo, Gaetano; Sammarco, Giuseppe; Vescio, Giuseppina; Pancholi, Shivam; A Hussein, Rand. - In: AGE AND AGEING. - ISSN 0002-0729. - 50:3(2021), pp. 617-630. [10.1093/ageing/afab026]
Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study
Teresa PerraMembro del Collaboration Group
;Alberto PorcuMembro del Collaboration Group
;
2021-01-01
Abstract
INTRODUCTION: Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear.METHODS: This multi-centre cohort study involved patients aged 18years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables.RESULTS: Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18-49: HR 3.57, CI 2.54-5.02), frailty (CFS 8 vs 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1-3: OR 7.00, CI 5.27-9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9.CONCLUSIONS: Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
