Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study
Mustafa Alsahab, Lucy Beishon, Bryony Brown, Elinor Burn, Jennifer Kirsty Burton, Natalie Cox, Melanie Dani, Muhammed Elhadi, Sarah Freshwater, Victoria Gaunt, Adam Gordon, Marie Goujon, Matthew Hale, Terry Lynn Hughes, Thomas Jackson, Benjamin Jelley, Asma Khan, Heena Khiroya, Rajni Lal, Katy Madden, Laura Magill, Jane Masoli, Tahir Masud, Lauren McCluskey, Natalie McNeela, Awolkhier Mohammedseid-Nurhussien, Hannah Moorey, Mary Ní Lochlainn, Krishnarajah Nirantharakumar, Kelvin Okoth, Christopher N Osuafor, Katherine Patterson, Grace M E Pearson, Rita Perry, Michala E. Pettitt, Jennifer Pigott, Thomas Pinkney, Terence J. Quinn, Abigail Reynolds, Sarah Richardson, Nik Sanyal, Adam Seed, Isobel Sleeman, C. R. de Soó, Claire J. Steves, W. David Strain, Joanne Taylor, Kelli Torsney, Carly Welch, Daisy Wilson, Miles D. Witham, Covid Collaborative, Hossam Aldein S Abd Elazeem, Mohammed Abdelhafez, Amir Abdelmalak, Omar Ahmed Abdelwahab, Osama Mohamed Ali Senussi Abdulhadi, Olubayode Adewole, Mohammed Ahmad, Eltayeb A Ahmed, Hazem A. Sayed Ahmed, Islam Ahmed, Mertcan Akçay, Yeşim Akdeniz, Emrah Akın, Carolyn Akladious, Francesco Alessandri, Ali Ali, Abdulmalek Aljafari, Abdulmoiz Aljafari, Mohammed Al‐Sadawi, Lobna Al-Sodani, Fatih Altıntoprak, Gitanjali Amaratungaz, Jocelyn Amer, Sylvia Amini, Taha Amir, C Anandarajah, Rachael Anders, Muhammed H Ansari, Kingsley Opoku Appiah, Jolene Atia, Catherine Atkin, Avinash Aujayeb, Elsayed M Awad, Mohammed A. Azab, Mohammad T. Azam, Sally Aziz, Ahmed Y. Azzam, Laxmi Babar, Laura Babb, Manpreet Badh, C L Baguneid, Emily J Bailey, Efstratia Baili, Sarah Baldwin, I Baloyiannis, Moulinath Bannerjee, Anna Barnard, Fabio Barra
Abstract
INTRODUCTION: Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), but the effect of frailty has been unclear. METHODS: This multi-centre cohort study involved patients aged 18 years 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, interquartile range [IQR] 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 versus 18-49: hazard ratio [HR] 3.57, confidence interval [CI] 2.54-5.02), frailty (CFS 8 versus 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease and cancer, but not delirium. Age, frailty (CFS 7 versus 1-3: odds ratio 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. CONCLUSION: 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.