Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study
| Title: | Clinical frailty, and not features of acute infection, is associated with late mortality in COVID‐19: a retrospective cohort study |
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| Authors: | Nikolaos I. Vlachogiannis, Kenneth F. Baker, Georgios Georgiopoulos, Charalampos Lazaridis, Ina Schim van der Loeff, Aidan T. Hanrath, Kateryna Sopova, Simon Tual‐Chalot, Aikaterini Gatsiou, Ioakim Spyridopoulos, Kimon Stamatelopoulos, Christopher J.A. Duncan, Konstantinos Stellos |
| Source: | Journal of Cachexia, Sarcopenia and Muscle, Vol 13, Iss 3, Pp 1502-1513 (2022) |
| Publisher Information: | Wiley, 2022. |
| Publication Year: | 2022 |
| Collection: | LCC:Diseases of the musculoskeletal system LCC:Human anatomy |
| Subject Terms: | COVID‐19, Late mortality, Frailty, 4C mortality score, Prognosis, Diseases of the musculoskeletal system, RC925-935, Human anatomy, QM1-695 |
| More Details: | Abstract Background Coronavirus disease 2019 (COVID‐19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID‐19 patients. Methods A total of 471 patients with polymerase chain reaction‐confirmed COVID‐19 were followed up for 9 months [median (inter‐quartile range) of follow‐up time: 271 (14) days] after hospital admission. COVID‐19‐related signs and symptoms, laboratory features, co‐morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. Results A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval—CI): 4C: 1.34 (1.25–1.45); CFS: 1.49 (1.33–1.66)] and late [OR (95% CI): 4C: 1.23 (1.12–1.36); CFS: 2.04 (1.62–2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732–0.825) vs. 0.723 (0.673–0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776–0.883) vs. 0.724 (0.650–0.798), respectively; P = 0.007]. Conclusions In our cohort, late mortality in COVID‐19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase. |
| Document Type: | article |
| File Description: | electronic resource |
| Language: | English |
| ISSN: | 2190-6009 2190-5991 |
| Relation: | https://doaj.org/toc/2190-5991; https://doaj.org/toc/2190-6009 |
| DOI: | 10.1002/jcsm.12966 |
| Access URL: | https://doaj.org/article/e0d3ef2462ff43bdb9d7f28550b31986 |
| Accession Number: | edsdoj.0d3ef2462ff43bdb9d7f28550b31986 |
| Database: | Directory of Open Access Journals |
| ISSN: | 21906009 21905991 |
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| DOI: | 10.1002/jcsm.12966 |
| Published in: | Journal of Cachexia, Sarcopenia and Muscle |
| Language: | English |