S6 Frailty and mortality in COVID-19 patients: a retrospective analysis of a large series in a single-centre

IntroductionThe Rockwood clinical frailty score (CFS) has been recommended for use in assessing patients during the COVID-19 pandemic. However, a recent cohort study has suggested it has little impact on the hazard of dying due to COVID-19,1 while use to inform escalation decisions has proven contentious.MethodWe identified patients hospitalised with COVID-19 from 11 March 2020 to 28 April 2020. Age, gender, key co-morbidities, inpatient mortality, length of stay, CFS, respiratory support, chest X-ray (CXR) appearance and C-reactive protein (CRP) were collected retrospectively from electronic records and medical notes. Multiple imputation used for missing values (CFS n= 1; CRP n= 5; CXR n= 9). Univariate relationships with in-hospital mortality were examined (Fisher’s exact, T test and Mann-Whitney U as appropriate) and independent predictors of mortality were identified via backward stepwise logistic regression. CFS was verified in patients referred for CPAP/NIV on the Respiratory Support Unit (RSU; maximum level of care); mortality outcomes are separately shown.ResultsAmong 414 patients; mean age was 73 (SD 14.297) years, 241 males (58%), 135 died (33%) and median CFS 4 (IQR 2.75 – 5.00). Older age (mean 69.90 [SD 15.122] vs. 79.40 [SD 9.616]; p< 0.0001) and CFS (median 3 [IQR 2-4] vs. 5 [IQR 3-6]; p< 0.0001) were significantly associated with mortality. Mortality was higher in those invasively (10/13, 76.9%, p= 0.001) and non-invasively (16/32, 50.0%, p= 0.027) ventilated. Independent predictors associated with mortality are shown in table 1. Among patients receiving CPAP/NIV on the RSU, mortality increased with each CFS category (1–3 n=6/17, 35.3%;4–5 n=9/14, 64.3%;6–7 n=5/6, 83.3%).Abstract S6 Table 1Independent predictors of mortality in COVID-19 patientsConclusionWe report a large, single centre series of COVID-19 patients. Consecutive patients were identified, and missing data were few. CFS is a strong independent predictor of mortality in patients with COVID-19. This data would suggest that, in our population, the continuing use of CFS is important in our management and decision making in patients with COVID-19.ReferenceRK Owen, SP Conroy, N Taub, et al. Comparing associations between frailty and mortality in hospitalised older adults with or without COVID-19 infection: a retrospective observational study using electronic health records. Age and Ageing. 2020. doi.org/10.1093/ageing/afaa167