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
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- Alberto Zucchelli
- Department of Information Engineering, University of Brescia, Italy
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- Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
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- Andrea Armellini
- ASST Spedali Civili di Brescia, Montichiari, Italy
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- Emanuele Botteri
- ASST Spedali Civili di Brescia, Montichiari, Italy
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- Franco Nicosia
- ASST Spedali Civili di Brescia, Montichiari, Italy
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- Giuseppe Romanelli
- Department of Clinical and Experimental Sciences, University of Brescia, Italy
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- Eva Andrea Beindorf
- ASST Spedali Civili di Brescia, Montichiari, Italy
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- Paola Giansiracusa
- ASST Spedali Civili di Brescia, Montichiari, Italy
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- Emirena Garrafa
- Department of Molecular and Translational Medicine, University of Brescia, Italy
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- Luigi Ferrucci
- National Institute on Aging, Baltimore, Maryland
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- Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
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- Roberto Bernabei
- Department of Geriatrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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- Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
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- Anne B Newman
- editor
説明
<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 < .001), more frequently multimorbid (97.6 vs 52.8%; p < .001), and more likely frail (37.5 vs 4.1%; p < .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>
収録刊行物
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- The Journals of Gerontology: Series A
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The Journals of Gerontology: Series A 76 (3), e38-e45, 2020-11-20
Oxford University Press (OUP)