Frailty Assessment In The Emergency Department For Risk Stratification Of Covid-19 Patients ≥80 Years

Covino, Marcello; Russo, Andrea; Salini, Sara; De Matteis, Giuseppe; Simeoni, Benedetta; Della Polla, Davide; Sandroni, Claudio; Landi, Francesco; Gasbarrini, Antonio; Franceschi, Francesco

Objectives To evaluate, in a cohort of adults ≥ 80 years old, the overlapping effect of clinical severity, comorbidities, cognitive impairment, and frailty, for the in-hospital death risk stratification of COVID-19 older patients since emergency department (ED) admission. Design Single-center prospective observational cohort study. Setting and participants The study was conducted in the ED of a teaching hospital which is a referral center for COVID-19 in central Italy. We enrolled all COVID-19 patients ≥ 80 years old consecutively admitted to the ED between April 2020 and March 2021. Methods Clinical variables assessed in the ED were evaluated for the association with all-cause in-hospital death. Evaluated parameters were: severity of disease, frailty, comorbidities, cognitive impairment, delirium, and dependency in daily life activities. Cox regression analysis was used to identify independent risk factors for poor outcomes. Results 729 patients aged ≥ 80 years were enrolled (median age 85 years [interquartile range 82-89]; 346 were males (47.3%)). According to clinical frailty scale 61 (8.4%) were classified as fit, 417 (57.2%) as vulnerable, and 251 (34.4%) as frail. Severe disease (Hazard Ratio 1.87 [1.31-2.59]), ≥ 3 comorbidities (HR 1.54 [1.11-2.13]), male sex (HR 1.46 [1.14-1.87]) and frailty (HR 6.93 [1.69-28.27]) for vulnerable, and HR 12.55 [2.96-53.21] for frail were independent risk factors for in-hospital death. Conclusions and Implications The ED approach to older COVID-19 patients should take into account the functional and clinical characteristics of patients being admitted. A sole evaluation based on the clinical severity and the presence of comorbidities does not reflect the complexity of this population. A comprehensive evaluation based on clinical severity, multi-morbidity, and frailty could effectively predict the clinical risk of in-hospital death for COVID-19 patients ≥ 80 years at the time of ED presentation.