COVID-19 is not over and age is not enough: Using frailty forprognostication in hospitalized patients

Background: The Clinical Frailty Scale (CFS) has been proposed to guide the allocation of resources in acute care during the pandemic, but the association between frailty and COVID-19 prognosis is still unclear. We investigated the effect of frailty on mortality in hospitalized patients with COVID-19. Methods: Cohort study comprising 1,830 patients aged ≥ 50 years with COVID-19 admitted to a large academic medical center in Brazil. We screened baseline frailty using the CFS (1-9) and classified patients as fit to managing well (1-3), vulnerable (4), mildly (5), moderately (6), or severely frail to terminally ill (7-9). We also assessed the Frailty Index (0-1;frail > 0.25), a well-validated frailty measure. We used Cox proportional hazards models to estimate the association between frailty and time-to-death within 30 and 100 days of admission. We also examined whether frailty identified different mortality risk levels within strata of similar age and acute morbidity- measured by the Sequential Organ Failure Assessment (SOFA) score. Results: Patients had a median age of 66 years (range = 50-100 years), 58% were male, and 27% were frail according to the CFS. Compared with fit to managing well patients, those with greater CFS scores presented a higher risk of mortality (Table 1). The CFS also predicted different mortality risk levels within strata of similar age and SOFA scores and worked as an effect modifier on the association between acute morbidity and 100-day mortality (P-value for interaction = 0.01). Of note, the CFS achieved outstanding accuracy to identify frailty according to Frailty Index (area under the ROC curve = 0.94;95% CI = 0.93-0.95). Conclusions: Our results encourage the use of the CFS, alongside measures of acute morbidity, to guide clinicians in prognostication and resource allocation in hospitalized patients with COVID-19.

The Impact of Frailty on the Relationship between Life-Space Mobility and Quality of Life in Older Adults during the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic has led to abrupt restrictions of life-space mobility. The impact of shelter-in-place orders on older adults' health and well-being is still unclear. OBJECTIVE: To investigate the relationship between life-space mobility and quality of life (QoL) in older adults with and without frailty during the COVID-19 pandemic. DESIGN: Multicenter prospective cohort study based on structured telephone interviews. SETTING: Four geriatric outpatient clinics in the metropolitan area of Sao Paulo, Brazil. PARTICIPANTS: 557 community-dwelling adults aged 60 years and older. MEASUREMENTS: The Life-Space Assessment was used to measure community mobility before and during the COVID-19 pandemic, and a previously validated decrease of ≥ 5 points defined restricted life-space mobility. Frailty was assessed through the FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale. The impact of shelter-in-place orders on QoL was evaluated with the question «How is the COVID-19 pandemic affecting your QoL?¼, to which participants could respond «not at all¼, «to some extent¼, or «to a great extent¼. We used ordinal logistic regressions to investigate the relationship between restricted life-space mobility and impact on QoL, adjusting our analyses for demographics, frailty, comorbidities, cognition, functionality, loneliness, depression, and anxiety. We explored whether frailty modified the association between life-space mobility and impact on QoL. RESULTS: Participants were on average 80±8 years old, 65% were women, and 33% were frail. The COVID-19 quarantine led to a restriction of community mobility in 79% of participants and affected the QoL for 77% of participants. We found that restricted life-space mobility was associated with impact on QoL in older adults during the pandemic, although frailty modified the magnitude of the association (P-value for interaction=0.03). Frail participants who experienced restricted life-space mobility had twice the odds of reporting an impact on QoL when compared with non-frail individuals, with respective adjusted odds ratios of 4.20 (95% CI=2.36-7.50) and 2.18 (95% CI=1.33-3.58). CONCLUSION: Older adults experienced substantial decreases in life-space mobility during the COVID-19 pandemic, and this unexpected change impacted their QoL. Providers should be particularly watchful for the consequences of abrupt life-space restrictions on frail individuals.

Ckd is an independent risk factor for mortality in elderly patients affected by covid-19

Background: COVID-19 infection, an acute respiratory syndrome caused by coronavirus, has recently emerged as a lethal pandemic. Many elderly patients have chronic kidney disease and several other comorbidities that are associated with worse outcomes. We hypothesized chronic kidney disease (CKD) in elderly patients is an independent risk of mortality and more severe COVID-19, even after adjustment for comorbidities. Methods: This is a retrospective study, which enrolled 120 patients attended in a tertiary academic hospital divided into 2 groups, CKD (N=58) and non-CKD (N=62), according to eGFG < or ≥ 45ml/min/1.73m2. Charlson Comorbidity Index was used to evaluate comorbidities. Results: Patients with CKD have a significantly (all p values <0.05) higher leucocytes count, C-reactive protein, troponin, and lactate dehydrogenase;they also presented lower albumin. There was no difference in body mass index (BMI), lymphocytes, hemoglobin, age, gender, Charlson Comorbidity Index, or duration of symptoms between groups. Patients with CKD presented more severe COVID-19, as evidenced by a higher inspiratory oxygen fraction (p=0.001), major radiological findings in computed tomography, groundglass opacity (25% non-CKD and 53.1% CKD group presented lesion in >75% lung, p=0.042), and higher mortality (40.3% non-CKD vs. 75.9% CKD, p=0.0001). Logistic linear regression has revealed that CKD (RR 5.4, p=0.0001) was independent associated with mortality after adjustment for Charlson comorbidity Index (RR 1.2, p=0.034), age (p=0.551), gender (p=0.820) and BMI (p=0.941). Conclusions: Elderly patients with CKD have a higher and independent risk for mortality after COVID-19. These patients should be closely monitored during this pandemic situation in order to avoid further damage.