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Age and Frailty Are Independently Associated with Increased Mortality in COVID-19: Results of an International Multi-Centre Study

SSRN, ISSN: 1556-5068
2020
  • 4
    Citations
  • 2,960
    Usage
  • 7
    Captures
  • 0
    Mentions
  • 0
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    4
    • Citation Indexes
      4
  • Usage
    2,960
    • Abstract Views
      2,589
    • Downloads
      371
  • Captures
    7
  • Ratings
    • Download Rank
      161,891

Article Description

Introduction: Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear.  Methods: This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables.  Results: Data from 5711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54 – 83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18-49: HR 3.57, CI 2.54 – 5.02), frailty (CFS 8 vs 1-3: HR 3.03, CI 2.29 – 4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1-3: OR 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 likelihood of adverse outcomes increased across all grades of CFS from 4 to 9.  Conclusions: Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age. Funding Statement: The Geriatric Medicine Research Collaborative has previously received funding from the British Geriatrics Society for administrative and running costs. No project specific funding was obtained for this research. MW and SR acknowledge support from the NIHR Newcastle Biomedical Research Centre. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Local, regional, and national approvals were obtained from all participating sites. In the UK, this study was registered as clinical audit or service evaluation, with approval granted in line with local information governance policies, in line with assessment and guidance by the Health Research Authority. At the lead site (University Hospitals Birmingham NHS Trust) this study was registered as clinical audit (CARMS-15986). In other countries, local principal investigators were responsible for obtaining approvals in line with their local, regional, and national guidelines and recommendations. Only routinely collected data was collected and patient care was not altered by this study. Anonymised data was securely transferred to the Birmingham Centre for Prospective and Observational Studies (BiCOPS), University of Birmingham via REDCap. All sites were required to confirm that approvals were in place prior to being provided with logins; written data sharing agreements were arranged where requested by individual sites.

Bibliographic Details

Carly Welch; Daisy Wilson; Lauren McCluskey; Thomas A. Jackson; Krishnarajah Nirantharakumar; Thomas Pinkney; Laura Magill; Kelvin Okoth; Rita Perry; Michala Pettitt; Terry Hughes; Hannah Moorey; Sarah Richardson; Miles Witham; Mary Ni Lochlainn; Claire Steves; Jenni Burton; Terence Quinn; Adam Gordon; Muhammed Elhadi; Osama M.A.S. Abdulhadi; Hazem Ahmed; Ahmed K.M. Hadreiez; Ahmed A. Momen; Mosab A.A. Shaban; Bryony Brown; Matthew Hale; Benjamin Jelley; Victoria Gaunt; Melanie Dani; Chee Soo; Isobel Sleeman; Mustafa Alsahab; Katherine Patterson; Jennifer Pigott; Adam Seed; Kelli Torsney; Christopher N. Osuafor; Jane Masoli; David Strain; Elinor Burn; Lucy Beishon; Joanne Taylor; Natalie Cox; Marie Goujon; Sarah Freshwater; Tahir Masud; Grace M.E. Pearson; Natalie McNeela; Abigail Reynolds; Anthony Grubb; Elizabeth Holmes; Harjinder Kainth; Lara Reilly; Mark Whitsey; Asma Khan; Heena Khiroya; Katy Madden; Nik Sanyal; Awolkhier Mohammedseid-Nurhussien; Fatma D. Collins; Sharon Budd; Ellanna Griffin; Yue Guan; Deevia Hanji; Lily Lowes; Farhana Moomo; Olebu Ogochukwu; Katie Thin; Rajni Lal; Omar A. Abdelwahab; Elsayed M. Awad; Ahmed Y. Azzam; Ahmed Cordie; Ahmed O. Elmehrath; Mostafa El-Shazly; Almontacer E.B. Masood; Giuseppe Cecere; Aldo Rocca; Hossam Aldein S. Abd Elazeem; Mohammed H. Abdelhafez; Islam A. Ahmed; Shrouk M. Elghazaly; Helal F. Hetta; Mohamed Eltaher A.A. Ibrahim; Soha M. Mohamed; Aliae A.R. Mohamed Hussein; Mohamed M. Moustafa; Mariam Albatoul Nageh; Mahmoud M. Saad; Alshaimaa M. Saad; Omar Zein Elabedeen; Victoria Cox; Danielle Hunsley; Rebecca Ryall; Kathleen T. Shakespeare; Thyn; Rachael Webb; Deepthy Hari Madhavan; Laxmi Babar; Tina Doll; Agnieszka Felska; Daniel N. Guerero; Sandeep Karthikeyan; Anne Karunatilleke; Helena Lee; Emma Livesey; Amelia Roberts; Charlotte Roberts-Rhodes; Teresa Perra; Alberto Porcu; Antonio Buondonno; Vesna Hogan; Iain Wilkinson; Ioannis Baloyiannis; Jiannis Hajiioannou; Konstantinos Perivoliotis; George Tzovaras; Anna Fleck; Aine McGovern; Laura Babb; Emily Bailey; Jay Darley; Ioan M. Draghita; Alexander Hickman; Jason Kalloo; Akhil Kanzaria; Wasim Nawaz; Ambreen Sadiq; Rifa Cardoso; Margherita Faulkner; William Hurst; Ellen James; Aimee Leadbetter; Jordan Mayer; Tanya Robinson; Emma Stratton; Miriam Thake; Hannah Thould; Hannah Watson; Ravindra Belgamwar; Corrina Bentley; Sergio D.V. Ruiz; Nuria M. Sanz; Milagros Carrasco Prats; Pedro V.F. Fernández; Clara G. Francés; Esther M. Manuel; Miguel R. Marin; Pedro L. Morales; Patricia P. Pérez; María V. Soriano; Ismael Mora-Guzmán; Fabio Barra; Antonella Ferraiolo; Simone Ferrero; Claudio Gustavino; Chiara Kratochwila; Eric W. Etchill; Alodia Gabre-Kidan; Joshua H. Gray; Elliott R. Haut; Harsha Malapati; Sarah F. Rapaport; Kent A. Stevens; Dominique Vervoort; Mohammed A. Azab; Catherine Bryant; Hannah Cheney-Lowe; Catrin Cox; Andrew Crowe; Gordon Dick; Sarah Evans; Patrick C.P. Hogan; Kar Yee Law; Alexandra Richardson; Fabio Speranza; Kathryn Toppley; Julie Whitney; Eirene Yeung; Alexandros Charalabopoulos; Spyridon Davakis; Amalia Karapanou; Theodore Liakakos; Eustratia Mpaili; Maria Mpoura; Michail A. Sampanis; Nikolaos V. Sipsas; Parveen Doddamani; Victoria Haunton; Shahriar Kabir; Hannah Shaw; Chloe Warner; Yasmin K. NasrEldin; Nourhan A.A. Ghannam; Ali Ali; Sylvia Amini; James Belcher; Marie Giles; Hayley Jarvis; Nathan Jenko; Suvira Madan; Alexander Noar; Favour Nwolu; Jessica Parkin; Lauren C. Passby; Jarita Sivam; Michael Surtees; Joanne Wagland; Ruth West; David Williams; Avinash Aujayeb; Lindsey Dew; Catherine Dotchin; James M. Dundas; Elinor Edwards; Georgia F. Gilbert; Karl Jackson; Sarah H. Manning; Dominic Maxfield; Nicholas Moss; Declan C. Murphy; Ellen Tullo; Sarah H. Welsh; Enrico Pinotti; Francesco Alessandri; Gioia Brachini; Giancarlo Ceccarelli; Flavia Ciccarone; Pierfranco M. Cicerchia; Bruno Cirillo; Giorgio de Toma; Giulia Duranti; Enrico Fiori; Giovanni B. Fonsi; Pierfrancesco Lapolla; Simona Meneghini; Andrea Mingoli; Francesco Pugliese; Paolo Sapienza; Luigi Simonelli; Martina Zambon; Caterina Cattel; Laurenny Guzman; Hannah Dowell; Aina Ibukunoluwakitan; Fawsiya Mohamed; Claire Spice; Amanda Stafford; Jolene Atia; Catherine Atkin; Hannah Currie; Felicity Evison; Zeinab Majid; Maria Qurashi; Siobhan Coulter; Claire McDonald; Georgina Muir; Catherine O'Mahony; Caroline Tait; Rowan Davies; Katie Honney; Laura Winter; Olubayode Adewole; Amir Abdelmalak; Mohammed Ahmad; Muhammed H. Ansari; Kingsley Appiah; Rajesh Dwivedi; Hope Elrick; Hedra Ghobrial; Rosie Jackson; Sophie Jeffs; Sasha Jeyakumar; Eleanor Lunt; Bushra Muzammil; Sylvia Pytraczyk; Jonathan Sheldrake; Jennifer Smith; Hannah Tobiss; Mark Vettasseri; Ruth H. Willott; Hein Zaw; Moulinath Bannerjee; Jean Cummings; Barbara Hart; Tom Maughan; Clare Baguneid; Gabrielle Budd; Lizzie Moriarty; Omoteniola Odutola; Hannah Street; Alexis Carr; Sarah Baldwin; Hannah Bashir; Jake Gibbon; Amy Gray; Grace Lewis; Christina Page; Rosanna Varden; Mertcan Akcay; Yeşim Akdeniz; Emrah Akın; Fatih Altintoprak; Zülfü Bayhan; Recayi Capoglu; Hakan Demir; Necattin Firat; Emre Gonullu; Tarık Harmantepe; Baris Mantoglu; Ali Muhtaroglu; Merve Yigit; Yasin A. Yildiz; Lobna Al-Sodani; Nicole Burden; Evelyn Charsley; Thomas Kneen; Angeline Price; Emma Swinnerton; Yen Nee J. Bo; Hayley R. Boden; Reem Bulla; Alison Eastaugh; Mohammed Mubin; Anthony Umeadi; Stephanie Wallis; Megan Williamson; Yu Lelt Win; Eltayeb A. Ahmed; Abdulmoiz Aljafari; Abdulmalek Aljafari; Abdulkader Mohammad; Manpreet Badh; Amy Birchenough; Nick Coulthard; Alice Devaney; Ratnam Gandhi; Katharine Hood; Samuel North; Martha Pinkney; Ellie Shaw; Elisha Whelan; Gurinder Dogra; Claire Morris; Rebecca Wright; Stephen Lim; Lia Orlando; Harnish Patel; Prabhleen Puri; Sing Yang Sim; Carolyn Akladious; Gitanjali Amaratungaz; Taha Amir; Cheran Anandarajah; Rachael Anders; Sally Aziz; Anna Barnard; Monica Bawor; Laura Bremner; Hannah Bridgwater; Hejab Butt; Andra Caracostea; Theodore Chevallier; Victoria Comerford; Jack Cullen; Niamh Cunningham; Daniel Curley; Madeleine Daly; Nikhita Dattani; Benyamin Deldar; Arjun Desai; Nirali Desai; Jugdeep Dhesi; Maria Dias; Hannah C. Dooley; Samiullah Dost; Hiren Dusara; Alexander Emery; Cassandra Fairhead; Antia Fernandez; Gracie Fisk; Madeleine Garner; Hannah Gerretsen; Andrew Ghobrial; Zaynub Ghufoor; Deirdre Green; Charlotte Greene; Karla Griffith; Ayushi Gupta; Patrick Harrison; Aidan Haslam; Torben Heinsohn; Lindsay Hennah; Abigail Hobill; Katherine Hopkinson; Lara Howells; Nicole Hrouda; Irem Ishlek; Rishi Iyer; Nuha Kardaman; Mairead Kelly; Nicola I. Kelly; Hesham Khalid; Muhammad S. Khan; Haris Khan; Matthew King; Li Kok; Aneliya Kuzeva; Rebecca Lau; Gabriel Lee; Gavriella Levinson; Danielle Lis; Baguiasri Mandane; Jamie Mawhinney; Henry Maynard; Sophie McLachlan; Michelle Metcalf; John Millwood-Hargrave; Kelvin Miu; Aaliya Mohammed; Hamilton Morrin; Stephanie Mulhern; Daniel Muller; Varun Nadkarni; Hanna Nguyen; Alice O'Docherty; Sinead O'Dwyer; Marc Osterdahl; Ismini Panayotidis; Shefali Patel; Rose Penfold; Rupini Perinpanathan; Dina Radenkovic; Thurkka Rajeswaran; Tahmina Razzak; Emily Ross-Skinner; Hazel Sanghvi; Ross Sayers; Luca Scott; Sri Sivarajan; Katharine Stambollouian; Jack Stewart; Amybel Taylor; Hrisheekesh Vaidya; Vittoria Vergani; Madiha Virk; Vaishali Vyas; Eleanor Watkins; Catherine Wilcock; Mettha Wimalasundera; Stephanie Worrall; Natalie Yeo; Humza Yusuf; Adam H. Dyer; Cliona Ni Cheallaigh; Liam Townsend; Jocelyn Amer; Emily Lyon; Michael Sen; Mohammed Al-Sadawi; Adam Budzikoski; Ishmam Ibtida; Yusra Qaiser; Mohammad T. Azam; Asad J. Choudhry; William Marx; Ahmad Bouhuwaish; Ahmed S.A. Taher; Nikolaos Georgiou; Jade Man; Paul Reynolds; Benjaman To; Gilda de Paola; Gaetano Gallo; Giuseppe Sammarco; Giuseppina Vescio; Shivam Pancholi; Rand A. Hussein

Elsevier BV

Multidisciplinary

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