The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study
The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study
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DOI：
10.1016/s2468-2667(20)30146-8
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发表时间：
2020-08-01
影响因子：
50
通讯作者：
McCarthy, Kathryn
中科院分区：
文献类型：
--
作者：
Hewitt, Jonathan;Carter, Ben;McCarthy, Kathryn
背景COVID-19大流行给医疗保健系统带来了前所未有的压力。虚弱被用于COVID-19患者的临床决策，但虚弱在COVID-19患者中的患病率和影响尚不清楚。在COVID-19 in Older People（科普）研究中，我们旨在确定入院的COVID-19患者的虚弱患病率，并调查其与死亡率和住院时间的相关性。方法这是一项在英国10家医院和意大利1家医院进行的观察性队列研究。所有因COVID-19而入住参与医院的成年人（>= 18岁）均被纳入其中。排除了医院记录不完整的患者。该研究分析了常规生成的COVID-19患者的医院数据。由COVID-19专家团队使用临床虚弱量表（CFS）对虚弱进行评估，并根据评分对患者进行分组（1-2=健康; 3-4=脆弱，但不虚弱; 5-6=虚弱的初始体征，但具有一定程度的独立性; 7-9=严重或非常严重的虚弱）。主要结局是住院死亡率（从入院到死亡的时间和第7天死亡率）。结果在2020年2月27日至4月28日期间，我们招募了1564名COVID-19患者。中位年龄为74岁（IQR 61-83岁）; 903例（57.7%）为男性，661例（42.3%）为女性; 425例（27.2%）在数据截止日期（2020年4月28日）已死亡。772例（49.4%）被归类为虚弱（CFS 5-8），27例（1.7%）被归类为绝症（CFS 9）。与CFS 1-2相比，从入院到死亡时间的校正风险比为1.55 CFS 3- 4的（95% CI 1.00-2.41），1.83（1.15-2.91）CFS 5-6和2.39（1.50-3.81），第7天死亡率的校正比值比为1.22（95%CI 0.63-2.38），CFS 5-6为1.62（0.81-3.26），CFS 7- 9为3.12（1.56-6.24）。解释在大量因COVID-19入院的患者中，虚弱比年龄或合并症更能预测疾病结局。我们的研究结果支持使用CFS为因COVID-19入院的成年患者的医疗护理决策提供信息。版权所有（C）2020作者。爱思唯尔有限公司出版
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. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.