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2020 ; 5
(8
): e444-e451
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gab.com Text
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English Wikipedia
The effect of frailty on survival in patients with COVID-19 (COPE): a
multicentre, European, observational cohort study
#MMPMID32619408
Hewitt J
; Carter B
; Vilches-Moraga A
; Quinn TJ
; Braude P
; Verduri A
; Pearce L
; Stechman M
; Short R
; Price A
; Collins JT
; Bruce E
; Einarsson A
; Rickard F
; Mitchell E
; Holloway M
; Hesford J
; Barlow-Pay F
; Clini E
; Myint PK
; Moug SJ
; McCarthy K
Lancet Public Health
2020[Aug]; 5
(8
): e444-e451
PMID32619408
show ga
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.
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