Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients With COVID-19: A Retrospective Observational Study.

Christopher N Osuafor
* ORCID logo ,
Catriona Davidson
,
Alistair J Mackett
,
Marie Goujon
,
Lelane Van Der Poel
,
Vince Taylor
,
Jacobus Preller
,
Robert J B Goudie
ORCID logo ,
Victoria L Keevil
ORCID logo
Version 1 : Received: 4 January 2021 / Approved: 6 January 2021 / Online: 6 January 2021 (15:30:48 CET)

A peer-reviewed article of this Preprint also exists.

Osuafor, C.N.; Davidson, C.; Mackett, A.J.; Goujon, M.; Van Der Poel, L.; Taylor, V.; Preller, J.; Goudie, R.J.B.; Keevil, V.L. Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study. Geriatrics 2021, 6, 11. Osuafor, C.N.; Davidson, C.; Mackett, A.J.; Goujon, M.; Van Der Poel, L.; Taylor, V.; Preller, J.; Goudie, R.J.B.; Keevil, V.L. Clinical Features, Inpatient Trajectories and Frailty in Older Inpatients with COVID-19: A Retrospective Observational Study. Geriatrics 2021, 6, 11.

Abstract

Introduction: We describe the clinical features and inpatient trajectories of older adults hospitalized with COVID-19, and explore relationships with frailty. Methods: This retrospective observational study included older adults admitted as an emergency to a University Hospital who were diagnosed with COVID-19. Patient characteristics and hospital outcomes, primarily inpatient death or death within 14 days of discharge, were described for the whole cohort and by frailty status. Associations with mortality were further evaluated using Cox Proportional Hazards Regression (Hazard Ratio [HR], 95% Confidence Interval). Results: 214 patients (94 women) were included of whom 142 (66.4%) were frail with a median Clinical Frailty Scale (CFS) score of 6. Frail compared to non-frail patients were more likely to present with atypical symptoms including new or worsening confusion (45.1% vs 20.8%, p<0.001) and were more likely to die (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were independent predictors of death and a dose-response association between frailty and mortality was observed (CFS 1-4: reference; CFS 5-6: HR 1.78, 95% CI 0.90, 3.53; CFS 7-8: HR 2.57, 95% CI 1.26, 5.24). Conclusions: Clinicians should have a low threshold for testing for COVID-19 in older and frail patients during periods of community viral transmission and diagnosis should prompt early advanced care planning.

Keywords

atypical presentation; COVID-19; frailty; mortality; older patients

Subject

Medicine and Pharmacology, Immunology and Allergy

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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