BACKGROUND: The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals . One of the potential prognostic indicators in patients with COVID-19 is frailty . The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations . Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients .
METHODS: A prospective multicentre study of COVID-19 patients & #8805; 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted . The primary endpoint was 30-day mortality . Frailty was assessed using the clinical frailty scale . Additionally, comorbidities, management strategies and treatment limitations were recorded .
RESULTS: The study included 1346 patients (28% female) with a median age of 75 years (IQR 72-78, range 70-96), 16.3% were older than 80 years, and 21% of the patients were frail . The overall survival at 30 days was 59% (95% CI 56-62), with 66% (63-69) in fit , 53% (47-61) in vulnerable and 41% (35-47) in frail patients (p <0.001). In frail patients, there was no difference in 30-day survival between different age categories . Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation . In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival .
CONCLUSION: Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities . Trial registration Clinicaltrials.gov: NCT04321265, registered 19 March 2020.