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Alsahab M, Beishon L, Brown B, Burn E, Burton JK, Cox N, Dani M, Elhadi M, Freshwater S, Gaunt V, Gordon A, Goujon M, Hale M, Hughes T, Jackson TA, Jelley B, Khan A, Khiroya H, Lal R, Madden K, Magill L, Masoli J, Masud T, McCluskey L, McNeela N, Mohammedseid-Nurhussien A, Moorey H, Lochlainn MN, Nirantharakumar K, Okoth K, Osuafor CN, Patterson K, Pearson GME, Perry R, Pettitt M, Pigott J, Pinkney T, Quinn T, Reynolds A, Richardson S, Sanyal N, Seed A, Sleeman I, Soo C, Steves C, Strain WD, Taylor J, Torsney K, Welch C, Wilson D, Witham M, Elazeem HASA, Abdelhafez MH, Abdelmalak A, Abdelwahab OA, Abdulhadi OMAS, Adewole O, Ahmad M, Ahmed EA, Ahmed H, Ahmed IA, Akcay M, Akdeniz Y, Akın E, Akladious C, Alessandri F, Ali A, Aljafari A, Aljafari A, Al-Sadawi M, Al-Sodani L, Altintoprak F, Amaratungaz G, Amer J, Amini S, Amir T, Anandarajah C, Anders R, Ansari MH, Appiah K, Atia J, Atkin C, Aujayeb A, Awad EM, Azab MA, Azam MT, Aziz S, Azzam AY, Babar L, Babb L, Badh M, Baguneid C, Bailey 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Dowell H, Draghita IM, Dundas JM, Duranti G, Dusara H, Dwivedi R, Dyer AH, Eastaugh A, Edwards E, Elghazaly SM, Elmehrath AO, Elrick H, El-Shazly M, Emery A, Etchill EW, Evans S, Evison F, Fairhead C, Faulkner M, Felska A, Fernandez A, Fernández-Fernández PV, Ferraiolo A, Ferrero S, Fiori E, Firat N, Fisk G, Fleck A, Fonsi GB, Gabre-Kidan A, Gallo G, Gandhi R, Garner M, Georgiou N, Gerretsen H, Ghannam NAA, Ghobrial A, Ghobrial H, Ghufoor Z, Gibbon J, Gilbert GF, Giles M, Giménez-Francés C, Gonullu E, Gray A, Gray JH, Green D, Greene C, Griffin E, Griffith K, Grubb A, Guan Y, Guerero DN, Gupta A, Gustavino C, Guzman L, Hadreiez AKM, Hajiioannou J, Hanji D, Madhavan DH, Harmantepe T, Harrison P, Hart B, Haslam A, Haunton V, Haut ER, Heinsohn T, Hennah L, Hetta HF, Hickman A, Hobill A, Hogan PCP, Hogan V, Holmes E, Honney K, Hood K, Hopkinson K, Howells L, Hrouda N, Hunsley D, Hurst W, Hussein RA, Ibrahim MEAA, Ibtida I, Ibukunoluwakitan A, Ishlek I, Iyer R, Jackson K, Jackson R, James 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Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study. Age Ageing 2021; 50:617-630. [PMID: 33543243 PMCID: PMC7929433 DOI: 10.1093/ageing/afab026] [Show More Authors] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/09/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Increased mortality has been demonstrated in older adults with coronavirus disease 2019 (COVID-19), but the effect of frailty has been unclear. METHODS This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS) and delirium on risk of increased care requirements on discharge, adjusting for the same variables. RESULTS Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, interquartile range [IQR] 54-83; 55.2% male). The risk of death increased independently with increasing age (>80 versus 18-49: hazard ratio [HR] 3.57, confidence interval [CI] 2.54-5.02), frailty (CFS 8 versus 1-3: HR 3.03, CI 2.29-4.00) inflammation, renal disease, cardiovascular disease and cancer, but not delirium. Age, frailty (CFS 7 versus 1-3: odds ratio 7.00, CI 5.27-9.32), delirium, dementia and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. CONCLUSION Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.
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