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Observational Study
. 2020 Aug;5(8):e444-e451.
doi: 10.1016/S2468-2667(20)30146-8. Epub 2020 Jun 30.

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

Jonathan Hewitt  1 , Ben Carter  2 , Arturo Vilches-Moraga  3 , Terence J Quinn  4 , Philip Braude  5 , Alessia Verduri  6 , Lyndsay Pearce  7 , Michael Stechman  8 , Roxanna Short  9 , Angeline Price  10 , Jemima T Collins  11 , Eilidh Bruce  12 , Alice Einarsson  13 , Frances Rickard  5 , Emma Mitchell  5 , Mark Holloway  5 , James Hesford  5 , Fenella Barlow-Pay  14 , Enrico Clini  6 , Phyo K Myint  15 , Susan J Moug  16 , Kathryn McCarthy  17 ; COPE Study Collaborators
Collaborators, Affiliations
Observational Study

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

Jonathan Hewitt et al. Lancet Public Health. 2020 Aug.

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.

Funding: None.

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Figures

Figure 1
Figure 1
Overall survival by CFS category CFS=clinical frailty score.
Figure 2
Figure 2
Overall survival by age
Figure 3
Figure 3
Time to discharge from hospital by CFS CFS=clinical frailty score.
See this image and copyright information in PMC

Comment in

  • Frailty and mortality in patients with COVID-19.
    Laurent MR. Laurent MR. Lancet Public Health. 2020 Nov;5(11):e579. doi: 10.1016/S2468-2667(20)30227-9. Lancet Public Health. 2020. PMID: 33120040 Free PMC article. No abstract available.
  • Frailty and mortality in patients with COVID-19.
    Darvall JN, Bellomo R, Young PJ, Rockwood K, Pilcher D. Darvall JN, et al. Lancet Public Health. 2020 Nov;5(11):e580. doi: 10.1016/S2468-2667(20)30228-0. Lancet Public Health. 2020. PMID: 33120041 Free PMC article. No abstract available.
  • Frailty and mortality in patients with COVID-19.
    Pan D, Sze S, Minhas JS, Squire IB, Pareek M. Pan D, et al. Lancet Public Health. 2020 Nov;5(11):e581. doi: 10.1016/S2468-2667(20)30229-2. Lancet Public Health. 2020. PMID: 33120042 Free PMC article. No abstract available.
  • Frailty and mortality in patients with COVID-19 - Authors' reply.
    McCarthy K, Hewitt J, Myint PK, Quinn T, Carter B. McCarthy K, et al. Lancet Public Health. 2020 Nov;5(11):e582. doi: 10.1016/S2468-2667(20)30224-3. Lancet Public Health. 2020. PMID: 33120043 Free PMC article. No abstract available.

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