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

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  • Alessandra Marengoni
    Department of Clinical and Experimental Sciences, University of Brescia, Italy
  • Alberto Zucchelli
    Department of Information Engineering, University of Brescia, Italy
  • Davide Liborio Vetrano
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
  • Andrea Armellini
    ASST Spedali Civili di Brescia, Montichiari, Italy
  • Emanuele Botteri
    ASST Spedali Civili di Brescia, Montichiari, Italy
  • Franco Nicosia
    ASST Spedali Civili di Brescia, Montichiari, Italy
  • Giuseppe Romanelli
    Department of Clinical and Experimental Sciences, University of Brescia, Italy
  • Eva Andrea Beindorf
    ASST Spedali Civili di Brescia, Montichiari, Italy
  • Paola Giansiracusa
    ASST Spedali Civili di Brescia, Montichiari, Italy
  • Emirena Garrafa
    Department of Molecular and Translational Medicine, University of Brescia, Italy
  • Luigi Ferrucci
    National Institute on Aging, Baltimore, Maryland
  • Laura Fratiglioni
    Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
  • Roberto Bernabei
    Department of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
  • Graziano Onder
    Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
  • Anne B Newman
    editor

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<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>We evaluated whether frailty and multimorbidity predict in-hospital mortality in patients with COVID-19 beyond chronological age.</jats:p> </jats:sec> <jats:sec> <jats:title>Method</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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 &lt; .001), more frequently multimorbid (97.6 vs 52.8%; p &lt; .001), and more likely frail (37.5 vs 4.1%; p &lt; .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.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>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.</jats:p> </jats:sec>

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