期刊
GERIATRICS
卷 7, 期 5, 页码 -出版社
MDPI
DOI: 10.3390/geriatrics7050087
关键词
older people; COVID-19; frailty; clinical frailty scale; modified frailty index; prognosis
资金
- NIHR Maudsley Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust
- King's College London
- MRC/NIHR Clinical Academic Research Partnership Grant (CARP) [MR/T023902/1]
- Cambridge BHF Centre of Research Ex-cellence (CRE) [RE/18/1/34212]
- UKRI Medical Research Council [MC_UU_00002/2]
- NIHR Cambridge Biomedical Research Centre [BRC-121520014]
- Cancer Research UK Cambridge Centre
This study compared the prognostic utility of two frailty assessment methods (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in predicting mortality among older adults hospitalized with COVID-19. The results demonstrated that CFS had superior prognostic value compared to mFI in predicting mortality following COVID-19.
Background: There is no consensus on the optimal method for the assessment of frailty. We compared the prognostic utility of two approaches (modified Frailty Index [mFI], Clinical Frailty Scale [CFS]) in older adults (>= 65 years) hospitalised with COVID-19 versus age. Methods: We used a test and validation cohort that enrolled participants hospitalised with COVID-19 between 27 February and 30 June 2020. Multivariable mixed-effects logistic modelling was undertaken, with 28-day mortality as the primary outcome. Nested models were compared between a base model, age and frailty assessments using likelihood ratio testing (LRT) and an area under the receiver operating curves (AUROC). Results: The primary cohort enrolled 998 participants from 13 centres. The median age was 80 (range:65-101), 453 (45%) were female, and 377 (37.8%) died within 28 days. The sample was replicated in a validation cohort of two additional centres (n = 672) with similar characteristics. In the primary cohort, both mFI and CFS were associated with mortality in the base models. There was improved precision when fitting CFS to the base model +mFI (LRT = 25.87, p < 0.001); however, there was no improvement when fitting mFI to the base model +CFS (LRT = 1.99, p = 0.16). AUROC suggested increased discrimination when fitting CFS compared to age (p = 0.02) and age +mFI (p = 0.03). In contrast, the mFI offered no improved discrimination in any comparison (p > 0.05). Similar findings were seen in the validation cohort. Conclusions: These observations suggest the CFS has superior prognostic value to mFI in predicting mortality following COVID-19. Our data do not support the use of the mFI as a tool to aid clinical decision-making and prognosis.
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