Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people
Outcomes from COVID-19 across the range of frailty: excess mortality in fitter older people
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DOI：
10.1007/s41999-020-00354-7
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发表时间：
2020-07-18
影响因子：
3.8
通讯作者：
Davis, Daniel
中科院分区：
文献类型：
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作者：
Miles, Amy;Webb, Thomas E.;Davis, Daniel
摘要要点目的描述在一组因新冠肺炎来医院就诊的老年患者中，虚弱、种族、社会经济地位和死亡率之间的关系。发现虚弱似乎与新冠肺炎术后的死亡率无关，尽管明显的交互作用表明，与虚弱的患者相比，钳工的额外死亡率要高得多。消息脆弱性可能不是新冠肺炎预后的一个很好的衡量标准，根据发病前的脆弱性，不同的死亡途径可能存在不同的机制。我们的目标是量化新冠肺炎的死亡率，并确定与脆弱性和其他人口统计学因素的任何交互作用。方法选择70岁以上住院患者为研究对象，将同期收治的新冠肺炎患者与非新冠肺炎患者进行比较。对脆弱性进行了前瞻性测量，并通过与国家和地方法定报告相联系来确定死亡率。结果在217例新冠肺炎患者和160例对照中，高龄和南亚民族尽管与社会经济地位无关，但与较高的死亡率有关。对于脆弱性，病例组(HR 1.02，95%CI 0.93-1.12)和对照组(HR 1.99，95%CI 1.46-2.72)的效应大小有明显差异，在多变量模型中存在交互作用项(HR 0.51，95%CI 0.37-0.71)。结论我们的研究结果提示：(1)虚弱不能很好地判断新冠肺炎的预后；(2)与更虚弱的老年患者相比，虚弱的死亡路径可能不同。
Key summary pointsAim To describe associations between frailty, ethnicity, socioeconomic position and mortality in a cohort of older patients presenting to hospital with COVID-19. Findings Frailty did not appear to be associated with mortality rates after COVID-19, though an interaction was evident indicating much larger excess mortality in fitter, compared with frailer patients. Message Frailty may not be a good measure of prognosis in COVID-19 and different mechanisms may underlie pathways to death depending on pre-morbid frailty.Purpose Our aim was to quantify the mortality from COVID-19 and identify any interactions with frailty and other demographic factors. Methods Hospitalised patients aged >= 70 were included, comparing COVID-19 cases with non-COVID-19 controls admitted over the same period. Frailty was prospectively measured and mortality ascertained through linkage with national and local statutory reports. Results In 217 COVID-19 cases and 160 controls, older age and South Asian ethnicity, though not socioeconomic position, were associated with higher mortality. For frailty, differences in effect size were evident between cases (HR 1.02, 95% CI 0.93-1.12) and controls (HR 1.99, 95% CI 1.46-2.72), with an interaction term (HR 0.51, 95% CI 0.37-0.71) in multivariable models. Conclusions Our findings suggest that (1) frailty is not a good discriminator of prognosis in COVID-19 and (2) pathways to mortality may differ in fitter compared with frailer older patients.