Frailty is associated with in-hospital mortality in older hospitalised COVID-19 patients in the Netherlands: the COVID-OLD study

Laura C. Blomaard*, Carolien M. J. van der Linden, Jessica M. van der Bol, Steffy W. M. Jansen, Harmke A. Polinder-Bos, Hanna C. Willems, Jan Festen, Dennis G. Barten, Anke J. Borgers, Jeannet C. Bos, Frederiek van den Bos, Esther J. M. de Brouwer, Floor J. A. van Deudekom, Suzanne C. van Dijk, Marielle H. Emmelot-Vonk, Raya E. S. Geels, Esther M. M. van de Glind, Bas de Groot, Liesbeth Hempenius, Ad M. KamperLinda M. Kampschreur, Marre M. M. de Koning, Geert Labots, Roy Looman, Jacinta A. Lucke, Huub A. A. M. Maas, Francesco U. S. Mattace-Raso, Rachida El Moussaoui, Barbara C. van Munster, Kees van Nieuwkoop, Leanne Ble Oosterwijk, Marlies Em Regtuijt, Sarah H. M. Robben, Rikje Ruiter, Aisha M. Salarbaks, Henrike J. Schouten, Orla M. Smit, Rosalinde A. L. Smits, Petra E. Spies, Ralph Vreeswijk, Oscar J. de Vries, Marjolein A. Wijngaarden, Caroline E. Wyers, Simon P. Mooijaart

*Corresponding author for this work

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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.

Original languageEnglish
Pages (from-to)631-640
Number of pages10
JournalAge and Ageing
Volume50
Issue number3
DOIs
Publication statusPublished - May-2021

Keywords

  • clinical frailty scale
  • COVID-19
  • frailty
  • SARS-CoV-2
  • older adults
  • SCREENING TOOL
  • MALNUTRITION
  • INPATIENTS

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