Internal Medicine Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Calle Pintor Baeza, 12. CP 03010, Alicante, Spain.
Endocrinology and Nutrition Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
BMC Geriatr. 2023 Jan 2;23(1):1. doi: 10.1186/s12877-022-03642-y.
Frailty is a physiological condition characterized by a decreased reserve to stressors. In patients with COVID-19, frailty is a risk factor for in-hospital mortality. The aim of this study was to assess the relationship between clinical presentation, analytical and radiological parameters at admission, and clinical outcomes according to frailty, as defined by the Clinical Frailty Scale (CFS), in old people hospitalized with COVID-19.
This retrospective cohort study included people aged 65 years and older and admitted with community-acquired COVID-19 from 3 March 2020 to 31 April 2021. Patients were categorized using the CFS. Primary outcomes were symptoms of COVID-19 prior to admission, mortality, readmission, admission in intensive care unit (ICU), and need for invasive mechanical ventilation. Analysis of clinical symptoms, clinical outcomes, and CFS was performed using multivariable logistic regression, and results were expressed as odds ratios (ORs) and 95% confidence intervals (CIs).
Of the 785 included patients, 326 (41.5%, 95% CI 38.1%-45.0%) were defined as frail (CFS ≥ 5 points): 208 (26.5%, 95% CI 23.5%-29.7%) presented mild-moderate frailty (CFS 5-6 points) and 118 (15.0%, 95% CI 12.7%-17.7%), severe frailty (7-9 points). After adjusting for epidemiological variables (age, gender, residence in a nursing home, and Charlson comorbidity index), frail patients were significantly less likely to present dry cough (OR 0.58, 95% CI 0.40-0.83), myalgia-arthralgia (OR 0.46, 95% CI 0.29-0.75), and anosmia-dysgeusia (OR 0.46, 95% CI 0.23-0.94). Confusion was more common in severely frail patients (OR 3.14; 95% CI 1.64-5.97). After adjusting for epidemiological variables, the risk of in-hospital mortality was higher in frail patients (OR 2.79, 95% CI 1.79-4.25), including both those with mild-moderate frailty (OR 1.98, 95% CI 1.23-3.19) and severe frailty (OR 5.44, 95% CI 3.14-9.42). Readmission was higher in frail patients (OR 2.11, 95% CI 1.07-4.16), but only in mild-moderate frailty (OR 2.35, 95% CI 1.17-4.75)..
Frail patients presented atypical symptoms (less dry cough, myalgia-arthralgia, and anosmia-dysgeusia, and more confusion). Frailty was an independent predictor for death, regardless of severity, and mild-moderate frailty was associated with readmission.
衰弱是一种以应激储备能力下降为特征的生理状态。在 COVID-19 患者中，衰弱是住院死亡率的一个危险因素。本研究的目的是评估根据临床虚弱量表（CFS）定义的虚弱与老年人因 COVID-19 住院时的临床表现、入院时的分析和影像学参数以及临床结局之间的关系。
本回顾性队列研究纳入了 2020 年 3 月 3 日至 2021 年 4 月 31 日期间因社区获得性 COVID-19 入院的年龄在 65 岁及以上的患者。患者使用 CFS 进行分类。主要结局是入院前的 COVID-19 症状、死亡率、再入院、入住重症监护病房（ICU）和需要有创机械通气。使用多变量逻辑回归分析临床症状、临床结局和 CFS，并以优势比（OR）和 95%置信区间（CI）表示结果。
在纳入的 785 名患者中，326 名（41.5%，95%CI 38.1%-45.0%）被定义为虚弱（CFS≥5 分）：208 名（26.5%，95%CI 23.5%-29.7%）表现为轻度至中度虚弱（CFS 5-6 分），118 名（15.0%，95%CI 12.7%-17.7%）表现为严重虚弱（7-9 分）。在调整了流行病学变量（年龄、性别、居住在养老院和 Charlson 合并症指数）后，虚弱患者出现干咳（OR 0.58，95%CI 0.40-0.83）、肌痛-关节痛（OR 0.46，95%CI 0.29-0.75）和嗅觉味觉丧失（OR 0.46，95%CI 0.23-0.94）的可能性明显降低。严重虚弱患者更容易出现意识混乱（OR 3.14；95%CI 1.64-5.97）。在调整了流行病学变量后，虚弱患者的住院死亡率更高（OR 2.79，95%CI 1.79-4.25），包括轻度至中度虚弱（OR 1.98，95%CI 1.23-3.19）和严重虚弱（OR 5.44，95%CI 3.14-9.42）。虚弱患者的再入院率更高（OR 2.11，95%CI 1.07-4.16），但仅在轻度至中度虚弱患者中（OR 2.35，95%CI 1.17-4.75）。
虚弱患者出现非典型症状（干咳、肌痛-关节痛和嗅觉味觉丧失较少，意识混乱较多）。无论严重程度如何，虚弱都是死亡的独立预测因素，轻度至中度虚弱与再入院有关。
