The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study.
Jonathan Hewitt,Jonathan Hewitt,Ben Carter,Arturo Vilches-Moraga,Arturo Vilches-Moraga,Terence J. Quinn,Philip Braude,Alessia Verduri,Lyndsay Pearce,Michael Stechman,Roxanna Short,Angeline Price,Jemima T. Collins,Eilidh Bruce,Alice Einarsson,Frances Rickard,Emma Mitchell,Mark Holloway,James Hesford,Fenella Barlow-Pay,Enrico Clini,Phyo K. Myint,Susan Moug,Kathryn McCarthy,Charlotte Davey,Sheila Jones,Kiah Lunstone,Alice Cavenagh,Charlotte Silver,Thomas Telford,Rebecca G. Simmons,Tarik El Jichi Mutasem,Sandeep Singh,Dolcie Paxton,Will Harris,Norman J. Galbraith,Emma Bhatti,Jenny Edwards,Siobhan Duffy,Carly Bisset,Ross Alexander,Madeline Garcia,Shefali Sangani,Thomas Kneen,Thomas Lee,Aine McGovern,Giovanni Guaraldi +46 more
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TLDR
The prevalence of frailty in patients with COVID-19 who were admitted to hospital is established and its association with mortality and duration of hospital stay is investigated and disease outcomes were better predicted by frailty than either age or comorbidity.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.read more
Citations
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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study
Fei Zhou,Ting Yu,Ronghui Du,Guohui Fan,Ying Liu,Zhibo Liu,Jie Xiang,Yeming Wang,Bin Song,Xiaoying Gu,Xiaoying Gu,Lulu Guan,Yuan Wei,Li Hui,Xudong Wu,Jiuyang Xu,Shengjin Tu,Yi Zhang,Hua Chen,Bin Cao +19 more
TL;DR: Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future.
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Associations between body-mass index and COVID-19 severity in 6·9 million people in England: a prospective, community-based, cohort study.
Min Gao,Carmen Piernas,Nerys M. Astbury,Julia Hippisley-Cox,Stephen O'Rahilly,Paul Aveyard,Susan A. Jebb +6 more
TL;DR: In this paper, a prospective, community-based, cohort study was conducted to examine the association between obesity and adverse outcomes after infection with SARS-CoV-2, including interactions with demographic and behavioural characteristics, type 2 diabetes, and other health conditions.
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Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study.
Michela Antonelli,Rose S. Penfold,Jordi Merino,Carole H. Sudre,Erika Molteni,Sarah Berry,Liane S Canas,Mark S. Graham,Kerstin Klaser,Marc Modat,Benjamin J. Murray,Eric Kerfoot,Liyuan Chen,Jie Deng,Marc F Österdahl,Marc F Österdahl,Nathan J. Cheetham,David A. Drew,Long H. Nguyen,Joan Capdevila Pujol,Christina Hu,Somesh Selvachandran,Lorenzo Polidori,Anna May,Jonathan Wolf,Andrew T. Chan,Alexander Hammers,Emma L. Duncan,Tim D. Spector,Sebastien Ourselin,Claire J. Steves,Claire J. Steves +31 more
TL;DR: In this article, the authors identify risk factors for post-vaccination SARS-CoV-2 infection and describe the characteristics of post-vaccination illness, using self-reported data from UK-based, adult users of the COVID Symptom Study mobile phone app, including demographics, geographical location, health risk factors, and COVID-19 test results, symptoms, and vaccinations.
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Vitamin D deficiency aggravates COVID-19: systematic review and meta-analysis.
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References
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TL;DR: The epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of patients with laboratory-confirmed 2019-nCoV infection in Wuhan, China, were reported.
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TL;DR: During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness, and patients often presented without fever, and many did not have abnormal radiologic findings.
Journal ArticleDOI
Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study.
Fei Zhou,Ting Yu,Ronghui Du,Guohui Fan,Ying Liu,Zhibo Liu,Jie Xiang,Yeming Wang,Bin Song,Xiaoying Gu,Xiaoying Gu,Lulu Guan,Yuan Wei,Li Hui,Xudong Wu,Jiuyang Xu,Shengjin Tu,Yi Zhang,Hua Chen,Bin Cao +19 more
TL;DR: Wang et al. as discussed by the authors used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death, including older age, high SOFA score and d-dimer greater than 1 μg/mL.
Journal ArticleDOI
Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area.
Safiya Richardson,Safiya Richardson,Jamie S. Hirsch,Jamie S. Hirsch,Mangala Narasimhan,James M. Crawford,Thomas McGinn,Thomas McGinn,Karina W. Davidson,Karina W. Davidson,Douglas P. Barnaby,Douglas P. Barnaby,Lance B Becker,John Chelico,John Chelico,Stuart L. Cohen,Stuart L. Cohen,Jennifer Cookingham,Kevin Coppa,Michael A Diefenbach,Andrew J. Dominello,Joan Duer-Hefele,Louise Falzon,Jordan Gitlin,Negin Hajizadeh,Negin Hajizadeh,Tiffany G. Harvin,David Hirschwerk,Eun Ji Kim,Eun Ji Kim,Zachary Kozel,Lyndonna Marrast,Lyndonna Marrast,Jazmin N. Mogavero,Gabrielle A. Osorio,Michael Qiu,Theodoros P. Zanos +36 more
TL;DR: This case series provides characteristics and early outcomes of sequentially hospitalized patients with confirmed COVID-19 in the New York City area and assesses outcomes during hospitalization, such as invasive mechanical ventilation, kidney replacement therapy, and death.
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A global clinical measure of fitness and frailty in elderly people
Kenneth Rockwood,Xiaowei Song,Chris MacKnight,Howard Bergman,David B. Hogan,Ian McDowell,Arnold Mitnitski +6 more
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