Dataset Information

Clinical Frailty Score vs Hospital Frailty Risk Score for predicting mortality and other adverse outcome in hospitalised patients with COVID-19: Spanish case series.

ABSTRACT:

Objectives

Frailty can be used as a predictor of adverse outcomes in people with coronavirus disease 2019 (COVID-19). The aim of the study was to analyse the prognostic value of two different frailty scores in patients hospitalised for COVID-19.

Material and methods

This retrospective cohort study included adult (≥18 years) inpatients with COVID-19 and took place from 3 March to 2 May 2020. Patients were categorised by Clinical Frailty Score (CFS) and Hospital Frailty Risk Score (HFRS). The primary outcome was in-hospital mortality, and secondary outcomes were tocilizumab treatment, length of hospital stay, admission in intensive care unit (ICU) and need for invasive mechanical ventilation. Results were analysed by multivariable logistic regression and expressed as odds ratios (ORs), adjusting for age, sex, kidney function and comorbidity.

Results

Of the 290 included patients, 54 were frail according to the CFS (≥5 points; prevalence 18.6%, 95% confidence interval [CI]: 14.4-23.7) vs 65 by HFRS (≥5 points; prevalence: 22.4%, 95% CI 17.8-27.7). Prevalence of frailty increased with age according to both measures: 50-64 years, CFS 1.9% vs HFRS 12.3%; 65-79 years, CFS 31.5% vs HFRS 40.0%; and ≥80 years, CFS 66.7% vs HFRS 40.0% (P < .001). CFS-defined frailty was independently associated with risk of death (OR 3.67, 95% CI 1.49-9.04) and less treatment with tocilizumab (OR 0.28, 95% CI 0.08-0.93). HFRS-defined frailty was independently associated with length of hospital stay over 10 days (OR 2.89, 95% CI 1.53-5.44), ICU admission (OR 4.18, 95% CI 1.84-9.52) and invasive mechanical ventilation (OR 5.93, 95% CI 2.33-15.10).

Conclusion

In the spring 2020 wave of the COVID-19 pandemic in Spain, CFS-defined frailty was an independent predictor for death, while frailty as measured by the HFRS was associated with length of hospital stay over 10 days, ICU admission and use of invasive mechanical ventilation.

SUBMITTER: Ramos-Rincon JM

PROVIDER: S-EPMC8420333 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundGlobally, an increasing number of vulnerable or frail patients are undergoing cardiac surgery. However, large-scale frailty data are often limited by the need for time-consuming frailty assessments. This study aimed to (1) create a retrospective registry-based frailty score (FS), (2) determine its effect on outcomes and age, and (3) health care costs.MethodsRetrospective data were obtained from the New Brunswick Heart Centre registry for all cardiac surgery patients between 2012 and 2017. A 20-point FS was created using available binary risk variables. The primary outcomes of interest most relevant to vulnerable patients were prolonged hospitalization, failure to be discharged home, and hospitalization bed cost. Composite outcome of prolonged hospitalization (>8 days) and/or non-home discharge were analyzed using multivariate analysis.ResultsA total of 3463 patients (mean age, 66 ± 10 years) were included in the final analysis. Tercile-based FSs were: low (0-4; n = 856), medium (5-7; n = 1709), high (≥8; n = 898). In unadjusted data, frail patients were older with more comorbidities. High FS patients had greater risks of prolonged hospitalization (median 7 vs 5 days; P < .001), lower home-discharge rates (51% vs 83%; P < .001), higher 30-day readmission rates (18% vs 10%; P < .001), and increased 30-day mortality rates (≤0.7% [low], >0.7% to ≤1.2% [medium], and >1.2% to 4.8% [high]; P < .001). After statistical adjustment, the FS was an independent predictor of composite outcome (odds ratio, 1.3: 95% CI, 1.26-1.35), and increased hospital bed costs.ConclusionsA registry-based FS can be used to identify vulnerable or frail patients undergoing cardiac surgery and was associated with poor outcomes independent of age. This highlights that although frailty defined by increased vulnerability is often associated with older age, it is not a surrogate for aging, thereby having important implications in reducing health system costs and efforts to provide streamlined care to the most vulnerable.