School of Medicine and Surgery, Bicocca Center of Bioinformatics, Biostatistics and Bioimaging, University of Milano-Bicocca, Monza, Monza-Brianza, Italy.
Division of Infectious and Tropical Diseases, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Panminerva Med. 2022 Mar;64(1):24-30. doi: 10.23736/S0031-0808.21.04506-7. Epub 2021 Nov 11.
Older people hospitalized for COVID-19 are at highest risk of death. Frailty Assessment can detect heterogeneity in risk among people of the same chronological age. We investigated the association between frailty and in-hospital and medium-term mortality in middle-aged and older adults with COVID-19 during the first two pandemic waves.
This study is an observational multicenter study. We recorded sociodemographic factors (age, sex), smoking status, date of symptom onset, biological data, need for supplemental oxygen, comorbidities, cognitive and functional status, in-hospital mortality. We calculated a Frailty Index (FI) as the ratio between deficits presented and total deficits considered for each patient (theoretical range 0-1). We also assessed the Clinical Frailty Scale (CFS). Mortality at follow-up was ascertained from a regional registry.
In total, 1344 patients were included; median age 68 years (Q1-Q3, 56-79); 857 (64%) were men. Median CFS score was 3 (Q1-Q3 2-5) and was lower in younger vs. older patients. Median FI was 0.06 (Q1-Q3 0.03-0.09) and increased with increasing age. Overall, 244 (18%) patients died in-hospital and 288 (22%) over a median follow-up of 253 days. FI and CFS were significantly associated with risk of death. In two different models using the same covariates, each increment of 0.1 in FI increased the overall hazard of death by 35% (HR=1.35, 95%CI 1.23-1.48), similar to the hazard for each increment of CFS (HR=1.37, 95%CI 1.25-1.50).
Frailty, assessed with the FI or CFS, predicts in-hospital and medium-term mortality and may help estimate vulnerability in middle-aged and older COVID-19 patients.
因 COVID-19 住院的老年人死亡风险最高。衰弱评估可以检测相同年龄人群的风险异质性。我们研究了在 COVID-19 大流行的前两个波次中，衰弱与中年和老年人住院期间和中期死亡率之间的关联。
这是一项观察性多中心研究。我们记录了社会人口学因素（年龄、性别）、吸烟状况、症状出现日期、生物学数据、补充氧气需求、合并症、认知和功能状态、住院死亡率。我们计算了衰弱指数（FI），即每个患者出现的缺陷与考虑的总缺陷之比（理论范围 0-1）。我们还评估了临床衰弱量表（CFS）。通过区域登记处确定随访时的死亡率。
共纳入 1344 例患者；中位年龄 68 岁（IQR，56-79）；857 例（64%）为男性。中位 CFS 评分为 3 分（IQR，2-5），且年轻患者的评分低于年长患者。中位 FI 为 0.06（IQR，0.03-0.09），且随年龄增加而增加。总体而言，244 例（18%）患者住院期间死亡，288 例（22%）在中位随访 253 天后死亡。FI 和 CFS 与死亡风险显著相关。在使用相同协变量的两个不同模型中，FI 每增加 0.1，全因死亡的总体风险增加 35%（HR=1.35，95%CI 1.23-1.48），与 CFS 每增加 1 分的风险相似（HR=1.37，95%CI 1.25-1.50）。
使用 FI 或 CFS 评估的衰弱可预测住院期间和中期死亡率，可能有助于评估中年和老年 COVID-19 患者的脆弱性。
