Barlow-Pay, Fenella

Braude, Philip

Bruce , Eilidh

Carter, Ben

Clini , Enrico

Collins , Jemima T.

COPE Study Collaborators

Einarsson, Alice

Hesford , James

Hewitt, Jonathan

Holloway, Mark

McCarthy, Kathryn

Mitchell, Emma

Moug, Susan J.

Myint, Phyo K.

Pearce, Lyndsay

Price , Angeline

Quinn, Terence J.

Rickard , Frances

Short , Roxanna

Stechman, Michael

Verduri , Alessia

Vilches-Moraga, Arturo

The Lancet Public Health

English

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. The Cope Study (COVID-19 in Older People) was an observational cohort study designed to address this evidence gap.
Methods: All adults, regardless of age, admitted consecutively with COVID-19 from 10 UK and one Italian hospital had demographic and diagnostic data collected. Frailty was assessed using the Clinical Frailty Score (CFS). The primary endpoint was in-hospital mortality (time to mortality and 7 day mortality) and time to discharge as the secondary outcome. Data were gathered between 27th February and 28th of April 2020. Data was analysed with a mixed-effects, Cox proportional hazards and Logistic regression models. 
Findings: Data were collected on 1564 people with a confirmed diagnosed of COVID-19: median age was 74 years old (IQR, 61-83), 901 were male (57.7%), 425 (27.2%) died in hospital. Using the Clinical Frailty Scale, the number of people who were classed as mildly frail or above was 51.1%. Both time to mortality and time to discharge worsened with increasing frailty, after adjustment for: age; sex; smoking; and comorbidities. The adjusted Hazard Ratio (aHR, 95%CI) for CFS 3-4 (managing well, vulnerable), 5-6 (mildly frail and frail) and 7-9 (severely frail, very severely frail and terminally ill) compared to CFS 1-2 (very fit, well) were 1.64 (1.06-2.55), 2.02 (1.27-3.20) and 2.66 (1.68-4.21) for time to mortality and 0.97 (0.79-1.19), 0.69 (0.53-0.89) and 0.63 (0.47-0.83) for the time to discharge.
Interpretation: In a large adult population of people with COVID-19, worsening frailty was associated with progressively increasing mortality and later discharge from hospital. These data provide evidence that frailty is not dependent on age and that the Clinical Frailty Scale can inform decision making about medical care in the adult COVID-19 hospital population

Hewitt, J

Carter, B

Vilches-Moraga, A

Quinn, TJ

Braude, P

Verduri, A

Pearce, L

Stechman, M

Short, R

Price, A

Collins, J

Bruce, E

Einarrson, A

Rickard, F

Mitchell, E

Holloway, M

Hesford, J

Barlow-Pay, F

Clini, E

Myint, PK

Moug, SJ

McCarthy, K.

Archivio istituzionale della ricerca - Università di Modena e Reggio Emilia

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

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.



Funding: 

None

Verduri, Alessia

Short, Roxanna

Price, Angeline

Collins, Jemima T.

Bruce, Eilidh

Rickard, Frances

Hesford, James

Clini, Enrico

on behalf of the COPE Study Collaborators, .

Enlighten

Aberdeen University Research

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

http://eprints.gla.ac.uk/220868/1/220868.pdf

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

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Archivio istituzionale della ricerca - Università di Modena e Reggio Emilia

Enlighten

Aberdeen University Research