Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

Abstract

Introduction:Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), butthe effect of frailty has been unclear.Methods:This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, usingroutinely collected data. We used Cox regression analysis to assess the impact of age, frailty and delirium on the risk ofinpatient mortality, adjusting for sex, illness severity, inflammation and co-morbidities. We used ordinal logistic regressionanalysis to assess the impact of age, Clinical Frailty Scale (CFS) and delirium on risk of increased care requirements ondischarge, 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 likelihoodof 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 needswas also increased in survivors of COVID-19 with frailty or older age