Beyond Chronological Age: Frailty and Multimorbidity Predict In-Hospital Mortality in Patients With Coronavirus Disease 2019

• Published in: The Journals of Gerontology: Series A Vol. 76; no. 3; pp. e38 - e45
• Main Authors: Marengoni, Alessandra, Zucchelli, Alberto, Vetrano, Davide Liborio, Armellini, Andrea, Botteri, Emanuele, Nicosia, Franco, Romanelli, Giuseppe, Beindorf, Eva Andrea, Giansiracusa, Paola, Garrafa, Emirena, Ferrucci, Luigi, Fratiglioni, Laura, Bernabei, Roberto, Onder, Graziano
• Format: Journal Article Web Resource
• Language: English
• Published: US Oxford University Press 01.03.2021
• Subjects: Aged; Aged, 80 and over; COVID-19 - epidemiology; COVID-19 - mortality; Female; Frail Elderly; Frailty - epidemiology; Geriatric Assessment; Hospital Mortality; Humans; Italy - epidemiology; Male; Multimorbidity; Pandemics; Risk Factors; SARS-CoV-2; Italy; COVID-19; Frailty; In-hospital mortality; Multimorbidity
• ISSN: 1079-5006; 1758-535X
• DOI: 10.1093/gerona/glaa291

Abstract Background We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age. Method A total of 165 patients admitted from March 8th to April 17th, 2020, with COVID-19 in an acute geriatric ward in Italy were included. Predisease frailty was assessed with the Clinical Frailty Scale (CFS). Multimorbidity was defined as the co-occurrence of ≥2 diseases in the same patient. The hazard ratio (HR) of in-hospital mortality as a function of CFS score and number of chronic diseases in the whole population and in those aged 70+ years were calculated. Results Among the 165 patients, 112 were discharged, 11 were transferred to intensive care units, and 42 died. Patients who died were older (81.0 vs 65.2 years, p < .001), more frequently multimorbid (97.6 vs 52.8%; p < .001), and more likely frail (37.5 vs 4.1%; p < .001). Less than 2.0% of patients without multimorbidity and frailty, 28% of those with multimorbidity only, and 75% of those with both multimorbidity and frailty died. Each unitary increment in the CFS was associated with a higher risk of in-hospital death in the whole sample (HR = 1.3; 95% CI = 1.05–1.62) and in patients aged 70+ years (HR = 1.29; 95% CI = 1.04–1.62), whereas the number of chronic diseases was not significantly associated with higher risk of death. The CFS addition to age and sex increased mortality prediction by 9.4% in those aged 70+ years. Conclusions Frailty identifies patients with COVID-19 at risk of in-hospital death independently of age. Multimorbidity contributes to prognosis because of the very low probability of death in its absence.