The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study

Jonathan Hewitt(Cardiff and Vale University Health Board), Ben Carter(King's College London), Arturo Vilches‐Moraga(University of Manchester), Terence J. Quinn(University of Glasgow), Philip Braude(North Bristol NHS Trust), Alessia Verduri(University of Modena and Reggio Emilia), Lyndsay Pearce(Salford Royal NHS Foundation Trust), Michael Stechman(Cardiff University), Roxanna Short(King's College London), Angeline Price(Salford Royal NHS Foundation Trust), Jemima Collins(Aneurin Bevan University Health Board), Eilidh Bruce(NHS Grampian), Alice Einarsson(Woodend Hospital), Frances Rickard(Southmead Hospital), Emma Mitchell(Southmead Hospital), M. Holloway(North Bristol NHS Trust), James Hesford(North Bristol NHS Trust), Fenella Barlow-Pay(Royal Alexandra Hospital), Enrico Clini(University of Modena and Reggio Emilia), Phyo Kyaw Myint(University of Aberdeen), Susan Moug(Royal Alexandra Hospital), Kathryn McCarthy(Southmead Hospital), Charlotte Davey, S Jones, Kiah Lunstone, A. J. M. Cavenagh(Woodend Hospital), Charlotte Silver, Thomas Telford, Rebecca K. Simmons, Tarik El Jichi Mutasem, Sandeep Singh, Dolcie Paxton, Will Harris, Norman Galbraith, Emma Bhatti(Southmead Hospital), Jenny Edwards, Siobhan Duffy, Carly Bisset, Ross Alexander, Madeline Garcia, Shefali Sangani, Thomas Kneen, Thomas Lee, Aine McGovern, Giovanni Guaraldi(University of Modena and Reggio Emilia)
The Lancet Public Health
June 30, 2020
10.1016/s2468-2667(20)30146-8
Cited by 683Open Access
Full Text

Abstract

BACKGROUND: The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients with COVID-19 who were admitted to hospital and investigate its association with mortality and duration of hospital stay. METHODS: This was an observational cohort study conducted at ten hospitals in the UK and one in Italy. All adults (≥18 years) admitted to participating hospitals with COVID-19 were included. Patients with incomplete hospital records were excluded. The study analysed routinely generated hospital data for patients with COVID-19. Frailty was assessed by specialist COVID-19 teams using the clinical frailty scale (CFS) and patients were grouped according to their score (1-2=fit; 3-4=vulnerable, but not frail; 5-6=initial signs of frailty but with some degree of independence; and 7-9=severe or very severe frailty). The primary outcome was in-hospital mortality (time from hospital admission to mortality and day-7 mortality). FINDINGS: Between Feb 27, and April 28, 2020, we enrolled 1564 patients with COVID-19. The median age was 74 years (IQR 61-83); 903 (57·7%) were men and 661 (42·3%) were women; 425 (27·2%) had died at data cutoff (April 28, 2020). 772 (49·4%) were classed as frail (CFS 5-8) and 27 (1·7%) were classed as terminally ill (CFS 9). Compared with CFS 1-2, the adjusted hazard ratios for time from hospital admission to death were 1·55 (95% CI 1·00-2·41) for CFS 3-4, 1·83 (1·15-2·91) for CFS 5-6, and 2·39 (1·50-3·81) for CFS 7-9, and adjusted odds ratios for day-7 mortality were 1·22 (95% CI 0·63-2·38) for CFS 3-4, 1·62 (0·81-3·26) for CFS 5-6, and 3·12 (1·56-6·24) for CFS 7-9. INTERPRETATION: In a large population of patients admitted to hospital with COVID-19, disease outcomes were better predicted by frailty than either age or comorbidity. Our results support the use of CFS to inform decision making about medical care in adult patients admitted to hospital with COVID-19. FUNDING: None.

Related Papers

No related papers found

Powered by citation graph analysis