The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study

Jonathan Hewitt, Ben Carter, Arturo Vilches-Moraga, Terence J. Quinn, Philip Braude, Alessia Verduri , Lyndsay Pearce, Michael Stechman, Roxanna Short , Angeline Price , Jemima T. Collins , Eilidh Bruce , Alice Einarsson, Frances Rickard , Emma Mitchell, Mark Holloway, James Hesford , Fenella Barlow-Pay, Enrico Clini , Phyo K. MyintSusan J. Moug, Kathryn McCarthy*, the COPE Study Collaborators

*Corresponding author for this work

Research output: Contribution to journalArticle

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Abstract

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.
Original languageEnglish
Pages (from-to)e444-e451
Number of pages8
JournalThe Lancet Public Health
Volume5
Issue number8
Early online date30 Jun 2020
DOIs
Publication statusPublished - Aug 2020

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    Hewitt, J., Carter, B., Vilches-Moraga, A., Quinn, T. J., Braude, P., Verduri , A., Pearce, L., Stechman, M., Short , R., Price , A., Collins , J. T., Bruce , E., Einarsson, A., Rickard , F., Mitchell, E., Holloway, M., Hesford , J., Barlow-Pay, F., Clini , E., ... the COPE Study Collaborators (2020). The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. The Lancet Public Health, 5(8), e444-e451. https://doi.org/10.1016/S2468-2667(20)30146-8