Original Article

Impact of Frailty on COVID-19 Hospitalizations: Results from the California State Inpatient Database

Authors: Muni Rubens, MD, PhD, Anshul Saxena, DDS, PhD, Venkataraghavan Ramamoorthy, PhD, Sandeep Appunni, MD, Md. Ashfaq Ahmed, PhD, Zhenwei Zhang, PhD, Yanjia Zhang, PhD, Rehan Sha, , Samer Fahmy, MD

Abstract

Objectives: Frail patients are at greater risk of experiencing adverse clinical outcomes in any critical illness due to decreased physiologic reserves, greater susceptibility to the adverse effects of treatment, and greater needs for intensive care. In this study, we sought to assess the prevalence of frailty and associated adverse in-hospital outcomes among coronavirus disease 2019 (COVID-19) hospitalizations using the 2020 California State Inpatient Database (SID).

Methods: For this study, we conducted a retrospective analysis of data from all COVID-19 hospital patients aged 18 years and older. We identified hospitalizations that were at high risk of frailty using the Hospital Frailty Risk Score. The primary outcome of our study was in-hospital mortality, and the secondary outcomes were prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit admission.

Results: The prevalence of frailty was 44.3% among COVID-19 hospitalizations. Using propensity score matching analysis, we found that the odds of mortality (odds ratio [OR] 4.54, 95% confidence interval [CI] 4.28–4.82), prolonged length of stay (OR 2.81, 95% CI 2.70–2.90), vasopressor use (OR 8.65, 95% CI 7.45–10.03), mechanical ventilation (OR 6.90, 95% CI 6.47–7.35), and intensive care unit admission (OR 7.17, 95% CI 6.71–7.66) were significantly higher among the group of frail patients.

Conclusion: Our findings show that frailty could be used for assessing and risk stratifying patients for improved hospital outcomes.
Posted in: Infectious Disease146

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References

1. Zhang S, Guo M,DuanL, et al. Development and validation of a risk factor-based system to predict short-term survival in adult hospitalized patients with COVID-19: a multicenter, retrospective, cohort study. Crit Care 2020;24:1–13.
 
2. Varikasuvu SR, Dutt N, Thangappazham B, et al. Diabetes and COVID-19: a pooled analysis related to disease severity and mortality. Prim Care Diabetes 2021;15:24–27.
 
3. Huang Y, Lu Y, Huang Y-M, et al. Obesity in patients with COVID-19: a systematic review and meta-analysis. Metabolism 2020;113:154378.
 
4. Sasson I. Age and COVID-19 mortality. Demogr Res 2021;44:379–396.
 
5. Biswas M, Rahaman S, Biswas TK, et al. Association of sex, age, and comorbidities with mortality in COVID-19 patients: a systematic review and meta-analysis. Intervirology 2021; 64:36–47.
 
6. Hewitt J, Carter B, McCarthy K, et al. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing 2019;48:388–394.
 
7. Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing 2012;41:142–147.
 
8. O’Caoimh R, Sezgin D, O’Donovan MR, et al. Prevalenceoffrailty in 62 countries across the world: a systematic review and meta-analysis of population-level studies. Age Ageing 2021; 50:96–104.
 
9. Smart R, Carter B, McGoven J, et al. Frailty exists in younger adults admitted as surgical emergency leading to adverse outcomes. J Frailty Aging 2017;6:219–223.
 
10. Joseph B, Jehan FS. The mobility and impact of frailty in the intensive care unit. Surg Clin 2017;97:1199–1213.
 
11. Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet 2019;394:1365–1375.
 
12. Hamidi M, Zeeshan M ,Leon-Risemberg V,et al.Frailty as a prognostic factor for the critically ill older adult trauma patients. Am J Surg 2019;218:484–489.
 
13. National Institute for Health and Care Excellence. COVID-19 rapid guideline: critical care in adults. https://www.nice.org.uk/news/articles/nice-updates-rapid-covid-19-guideline-on-critical-care. Published 2021. Accessed March 9, 2024.
 
14. Agency for Healthcare Research and Quality. Overview of the State Inpatient Databases (SID). https://hcup-us.ahrq.gov/sidoverview.jsp. Accessed March 1, 2024.
 
15. Vandenbroucke JP, Von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007;4:e297.
 
16. Gilbert T, Neuburger J, Kraindler J, et al. Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet 2018;391:1775–1782.
 
17. Subramaniam A, Tiruvoipati R, Green C, et al. Frailty status, timely goals of care documentation and clinical outcomes in older hospitalised medical patients. Intern Med J 2021;51:2078–2086.
 
18. Meyer M, Parik L, Greimel F, et al. Hospital Frailty Risk Score outperforms current risk stratification models in primary total hip and knee arthroplasty. J Arthroplasty 2021;36: 1533–1542.
 
19. Steinmeyer Z, Vienne-Noyes S, Bernard M, et al. Acute care of older patients with COVID-19: clinical characteristics and outcomes. Geriatrics 2020;5:65.
 
20. Mendes A, Serratrice C, Herrmann FR, et al. Predictors of in-hospital mortality in older patients with COVID-19: the COVID Age study. JAmMedDirAssoc2020;21:1546–1554.
 
21. Cunha AIL, Veronese N, de Melo Borges S, et al. Frailty as a predictor of adverse outcomes in hospitalized older adults: a systematic review and meta-analysis. Ageing Res Rev 2019;56:100960.
 
22. Zhang Y, Yuan M, Gong M, et al. Frailty and clinical outcomes in heart failure: a systematic review and meta-analysis. JAmMedDirAssoc2018;19:1003–1008.
 
23. Chinnadurai R, Ogedengbe O, Agarwal P, et al. Older age and frailty are the chief predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting—a cohort study. BMC Geriatr 2020;20:1–11.
 
24. Tehrani S, Killander A, Astrand P, et al. Risk factors for death in adult COVID-19 patients: frailty predicts fatal outcome in older patients. Int J Infect Dis 2021;102:415–421.
 
25. OwenRK,ConroySP,Taub N, etal. Comparing associations between frailty and mortality in hospitalised older adults with or without COVID-19 infection: a retrospective observational study using electronic health records. Age Ageing 2021;50:307–316.
 
26. Gritsenko K, Helander E, Webb MP, et al. Preoperative frailty assessment combined with prehabilitation and nutrition strategies: emerging concepts and clinical outcomes. Best Pract Res Clin Anaesthesiol 2020;34:199–212.
 
27. Chow WB, Rosenthal RA, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg 2012;215:453–466.
 
28. Qu T, Walston JD, Yang H, et al. Upregulated ex vivo expression of stress-responsive inflammatory pathway genes by LPS-challenged CD14+ monocytes in frail older adults. Mech Ageing Dev 2009;130:161–166.
 
29. Chen X, Mao G, Leng SX. Frailty syndrome: an overview. Clin Interv Aging 2014;9:433.
 
30. Miles A, Webb TE, Mcloughlin BC, et al. Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people. Eur Geriatr Med 2020;11:851–855.
 
31. Jansen FM, Prins RG, Etman A, et al. Physical activity inn on-frail and frail older adults. PloS One 2015;10:e0123168.
 
32. Murad K, Kitzman DW. Frailty and multiple comorbidities in the elderly patient with heart failure: implications for management. Heart Fail Rev 2012;17:581–588.
 
33. Hubbard RE, Maier AB, Hilmer SN, et al. Frailty in the face of COVID-19. Age Ageing 2020; 49:499–500.
 
34. Smithard DG, Haslam J. COVID-19 pandemic healthcare resource allocation, age and frailty. New Bioeth 2021;27:127–132.
 
35. Al Rihani SB, Smith MK, Bikmetov R, et al. Risk of adverse drug events following the virtual addition of COVID-19 repurposed drugs to drug regimens of frail older adults with polypharmacy. J Clin Med 2020;9:2591.
 
36. Kundi H, Çetin EHÖ, Canpolat U, et al. The role of frailty on adverse outcomes among older patients with COVID-19. J Infect 2020;81:944–951.
 
37. Hewitt J, Carter B, Vilches-Moraga A, et al. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. Lancet Public Health 2020;5:e444–e451.
 
38. Ellis G, Whitehead MA, Robinson D, et al. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011; 343:d6553.
 
39. Zampieri FG, Iwashyna TJ, Viglianti EM, et al. Association of frailty with short-term outcomes, organ support and resource use in critically ill patients. Intens Care Med 2018;44: 1512–1520.
 
40. Hubbard RE, Woodhouse KW. Frailty, inflammation and the elderly. Biogerontology 2010;11: 635–641.
 
41. Clegg A, Young J, Iliffe S, et al. Frailty in elderly people. Lancet 2013;381:752–762.
 
42. Attaway AH, Scheraga RG, Bhimraj A, et al. Severe covid-19 pneumonia: pathogenesis and clinical management. BMJ 2021;372:n436.
 
43. Berlin DA, Gulick RM, Martinez FJ. Severe covid-19. N Engl J Med 2020;383:2451–2460.