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Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection.

ABSTRACT: Older age and frailty are predictors of adverse outcomes in patients with COVID-19. In emergency medicine, patients do not present with the diagnosis, but with suspicion of COVID-19. The aim of this study was to assess the association of frailty and age with death or admission to intensive care in patients with suspected COVID-19. This single-centre prospective cohort study was performed in the Emergency Department of a tertiary care hospital. Patients, 65 years and older, with suspected COVID-19 presenting to the Emergency Department during the first wave of the pandemic were consecutively enrolled. All patients underwent nasopharyngeal SARS-CoV-2 PCR swab tests. Patients with a Clinical Frailty Scale (CFS) > 4, were considered to be frail. Associations between age, gender, frailty, and COVID-19 status with the composite adverse outcome of 30-day-intensive-care-admission and/or 30-day-mortality were tested. In the 372 patients analysed, the median age was 77 years, 154 (41.4%) were women, 44 (11.8%) were COVID-19-positive, and 125 (33.6%) were frail. The worst outcome was seen in frail COVID-19-patients with six (66.7%) adverse outcomes. Frailty (CFS > 4) and COVID-19-positivity were associated with an adverse outcome after adjustment for age and gender (frailty: OR 5.01, CI 2.56-10.17, p < 0.001; COVID-19: OR 3.47, CI 1.48-7.89, p = 0.003). Frailty was strongly associated with adverse outcomes and outperformed age as a predictor in emergency patients with suspected COVID-19.

SUBMITTER: Simon NR

PROVIDER: S-EPMC8199640 | biostudies-literature | 2021 Jun

REPOSITORIES: biostudies-literature

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Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection.

Simon Noemi R NR Jauslin Andrea S AS Rueegg Marco M Twerenbold Raphael R Lampart Maurin M Osswald Stefan S Bassetti Stefano S Tschudin-Sutter Sarah S Siegemund Martin M Nickel Christian H CH Bingisser Roland R

Journal of clinical medicine 20210602 11

Older age and frailty are predictors of adverse outcomes in patients with COVID-19. In emergency medicine, patients do not present with the diagnosis, but with suspicion of COVID-19. The aim of this study was to assess the association of frailty and age with death or admission to intensive care in patients with <i>suspected</i> COVID-19. This single-centre prospective cohort study was performed in the Emergency Department of a tertiary care hospital. Patients, 65 years and older, with <i>suspect ...[more]

PMID: 34199572

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Project description:BackgroundLittle is known about the association between acute mental changes and adverse outcomes in hospitalized adults with COVID-19.ObjectivesTo investigate the occurrence of delirium in hospitalized patients with COVID-19 and explore its association with adverse outcomes.DesignLongitudinal observational study.SettingTertiary university hospital dedicated to the care of severe cases of COVID-19 in São Paulo, Brazil.ParticipantsA total of 707 patients, aged 50 years or older, consecutively admitted to the hospital between March and May 2020.MeasurementsWe completed detailed reviews of electronic medical records to collect our data. We identified delirium occurrence using the Chart-Based Delirium Identification Instrument (CHART-DEL). Trained physicians with a background in geriatric medicine completed all CHART-DEL assessments. We complemented our baseline clinical information using telephone interviews with participants or their proxy. Our outcomes of interest were in-hospital death, length of stay, admission to intensive care, and ventilator utilization. We adjusted all multivariable analyses for age, sex, clinical history, vital signs, and relevant laboratory biomarkers (lymphocyte count, C-reactive protein, glomerular filtration rate, D-dimer, and albumin).ResultsOverall, we identified delirium in 234 participants (33%). On admission, 86 (12%) were delirious. We observed 273 deaths (39%) in our sample, and in-hospital mortality reached 55% in patients who experienced delirium. Delirium was associated with in-hospital death, with an adjusted odds ratio of 1.75 (95% confidence interval = 1.15-2.66); the association held both in middle-aged and older adults. Delirium was also associated with increased length of stay, admission to intensive care, and ventilator utilization.ConclusionDelirium was independently associated with in-hospital death in adults aged 50 years and older with COVID-19. Despite the difficulties for patient care during the pandemic, clinicians should routinely monitor delirium when assessing severity and prognosis of COVID-19 patients.

Dataset Information

Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection.

Publications

Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection.

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