Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

Mustafa Alsahab; Lucy Beishon; Bryony Brown; Elinor Burn; Jenni K. Burton; N Cox; Melanie Dani; Muhammed Elhadi; Sarah Freshwater; Victoria Gaunt; Adam Gordon; Marie Goujon; Matthew Hale; Terry Hughes; TA Jackson; Benjamin Jelley; A Khan; Heena Khiroya; Rajni Lal; Katy Madden; Laura Magill; Jane Masoli; Tahir Masud; Lauren McCluskey; Natalie McNeela; Awolkhier Mohammedseid-Nurhussien; Hannah Moorey; Mary Ni Lochlainn; Krishnarajah Nirantharakumar; Kelvin Okoth; Christopher N. Osuafor; Katherine Patterson; Grace M.E. Pearson; Rita Perry; Michala Pettitt; Jennifer Pigott; T Pinkney; Terence Quinn; A Reynolds; S Richardson; Nik Sanyal; Adam Seed; Isobel Sleeman; Chee Soo; Claire Steves; W. David Strain; J Taylor; Kelli Torsney; Carly Welch; Daisy Wilson; Miles Witham; HASA Elazeem; Mohammed H. Abdelhafez; Amir Abdelmalak; Omar A. Abdelwahab; Osama M.A.S. Abdulhadi; Olubayode Adewole; M Ahmad; EA Ahmed; H Ahmed; IA Ahmed; M Akcay; Y Akdeniz; E Akın; C Akladious; F Alessandri; Alessandri Ali; A Aljafari; A Aljafari; M Al-Sadawi; L Al-Sodani; F Altintoprak; G Amaratungaz; J Amer; S Amini; T Amir; C Anandarajah; R Anders; MH Ansari; K Appiah; J Atia; C Atkin; A Aujayeb; EM Awad; MA Azab; MT Azam; S Aziz; Y. Azzam; Laxmi Babar; Laura Babb; Manpreet Badh; Clare Baguneid; Emily Bailey; Victoria Haunton

doi:10.1093/ageing/afab026

Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

Mustafa Alsahab, Lucy Beishon, Bryony Brown, Elinor Burn, Jenni K. Burton, N Cox, Melanie Dani, Muhammed Elhadi, Sarah Freshwater, Victoria Gaunt, Adam Gordon, Marie Goujon, Matthew Hale, Terry Hughes, TA Jackson, Benjamin Jelley, A Khan, Heena Khiroya, Rajni Lal, Katy MaddenLaura Magill, Jane Masoli, Tahir Masud, Lauren McCluskey, Natalie McNeela, Awolkhier Mohammedseid-Nurhussien, Hannah Moorey, Mary Ni Lochlainn, Krishnarajah Nirantharakumar, Kelvin Okoth, Christopher N. Osuafor, Katherine Patterson, Grace M.E. Pearson, Rita Perry, Michala Pettitt, Jennifer Pigott, T Pinkney, Terence Quinn, A Reynolds, S Richardson, Nik Sanyal, Adam Seed, Isobel Sleeman, Chee Soo, Claire Steves, W. David Strain, J Taylor, Kelli Torsney, Carly Welch^*, Daisy Wilson, Miles Witham, HASA Elazeem, Mohammed H. Abdelhafez, Amir Abdelmalak, Omar A. Abdelwahab, Osama M.A.S. Abdulhadi, Olubayode Adewole, M Ahmad, EA Ahmed, H Ahmed, IA Ahmed, M Akcay, Y Akdeniz, E Akın, C Akladious, F Alessandri, Alessandri Ali, A Aljafari, A Aljafari, M Al-Sadawi, L Al-Sodani, F Altintoprak, G Amaratungaz, J Amer, S Amini, T Amir, C Anandarajah, R Anders, MH Ansari, K Appiah, J Atia, C Atkin, A Aujayeb, EM Awad, MA Azab, MT Azam, S Aziz, Y. Azzam, Laxmi Babar, Laura Babb, Manpreet Badh, Clare Baguneid, Emily Bailey, Victoria Haunton

^*Corresponding author for this work

Peninsula Medical School

University of Birmingham

Research output: Contribution to journal › Article › peer-review

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.

Original language	English
Pages (from-to)	617-630
Journal	Age and Ageing
Volume	50
Issue number	3
Early online date	5 Feb 2021
DOIs	https://doi.org/10.1093/ageing/afab026
Publication status	Published - 5 May 2021

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10.1093/ageing/afab026

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Alsahab, M., Beishon, L., Brown, B., Burn, E., Burton, J. K., 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., ... Haunton, V. (2021). 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 and Ageing, 50(3), 617-630. https://doi.org/10.1093/ageing/afab026

@article{620c6a4076ea48de872c194d6999affe,

title = "Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study",

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.",

author = "Mustafa Alsahab and Lucy Beishon and Bryony Brown and Elinor Burn and Burton, {Jenni K.} and N Cox and Melanie Dani and Muhammed Elhadi and Sarah Freshwater and Victoria Gaunt and Adam Gordon and Marie Goujon and Matthew Hale and Terry Hughes and TA Jackson and Benjamin Jelley and A Khan and Heena Khiroya and Rajni Lal and Katy Madden and Laura Magill and Jane Masoli and Tahir Masud and Lauren McCluskey and Natalie McNeela and Awolkhier Mohammedseid-Nurhussien and Hannah Moorey and Lochlainn, {Mary Ni} and Krishnarajah Nirantharakumar and Kelvin Okoth and Osuafor, {Christopher N.} and Katherine Patterson and Pearson, {Grace M.E.} and Rita Perry and Michala Pettitt and Jennifer Pigott and T Pinkney and Terence Quinn and A Reynolds and S Richardson and Nik Sanyal and Adam Seed and Isobel Sleeman and Chee Soo and Claire Steves and Strain, {W. David} and J Taylor and Kelli Torsney and Carly Welch and Daisy Wilson and Miles Witham and HASA Elazeem and Abdelhafez, {Mohammed H.} and Amir Abdelmalak and Abdelwahab, {Omar A.} and Abdulhadi, {Osama M.A.S.} and Olubayode Adewole and M Ahmad and EA Ahmed and H Ahmed and IA Ahmed and M Akcay and Y Akdeniz and E Akın and C Akladious and F Alessandri and Alessandri Ali and A Aljafari and A Aljafari and M Al-Sadawi and L Al-Sodani and F Altintoprak and G Amaratungaz and J Amer and S Amini and T Amir and C Anandarajah and R Anders and MH Ansari and K Appiah and J Atia and C Atkin and A Aujayeb and EM Awad and MA Azab and MT Azam and S Aziz and Y. Azzam and Laxmi Babar and Laura Babb and Manpreet Badh and Clare Baguneid and Emily Bailey and Victoria Haunton",

year = "2021",

month = may,

day = "5",

doi = "10.1093/ageing/afab026",

language = "English",

volume = "50",

pages = "617--630",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "3",

}

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, Y, Babar, L, Babb, L, Badh, M, Baguneid, C, Bailey, E & Haunton, V 2021, '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 and Ageing, vol. 50, no. 3, pp. 617-630. https://doi.org/10.1093/ageing/afab026

TY - JOUR

T1 - Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

AU - Alsahab, Mustafa

AU - Beishon, Lucy

AU - Brown, Bryony

AU - Burn, Elinor

AU - Burton, Jenni K.

AU - Cox, N

AU - Dani, Melanie

AU - Elhadi, Muhammed

AU - Freshwater, Sarah

AU - Gaunt, Victoria

AU - Gordon, Adam

AU - Goujon, Marie

AU - Hale, Matthew

AU - Hughes, Terry

AU - Jackson, TA

AU - Jelley, Benjamin

AU - Khan, A

AU - Khiroya, Heena

AU - Lal, Rajni

AU - Madden, Katy

AU - Magill, Laura

AU - Masoli, Jane

AU - Masud, Tahir

AU - McCluskey, Lauren

AU - McNeela, Natalie

AU - Mohammedseid-Nurhussien, Awolkhier

AU - Moorey, Hannah

AU - Lochlainn, Mary Ni

AU - Nirantharakumar, Krishnarajah

AU - Okoth, Kelvin

AU - Osuafor, Christopher N.

AU - Patterson, Katherine

AU - Pearson, Grace M.E.

AU - Perry, Rita

AU - Pettitt, Michala

AU - Pigott, Jennifer

AU - Pinkney, T

AU - Quinn, Terence

AU - Reynolds, A

AU - Richardson, S

AU - Sanyal, Nik

AU - Seed, Adam

AU - Sleeman, Isobel

AU - Soo, Chee

AU - Steves, Claire

AU - Strain, W. David

AU - Taylor, J

AU - Torsney, Kelli

AU - Welch, Carly

AU - Wilson, Daisy

AU - Witham, Miles

AU - Elazeem, HASA

AU - Abdelhafez, Mohammed H.

AU - Abdelmalak, Amir

AU - Abdelwahab, Omar A.

AU - Abdulhadi, Osama M.A.S.

AU - Adewole, Olubayode

AU - Ahmad, M

AU - Ahmed, EA

AU - Ahmed, H

AU - Ahmed, IA

AU - Akcay, M

AU - Akdeniz, Y

AU - Akın, E

AU - Akladious, C

AU - Alessandri, F

AU - Ali, Alessandri

AU - Aljafari, A

AU - Al-Sadawi, M

AU - Al-Sodani, L

AU - Altintoprak, F

AU - Amaratungaz, G

AU - Amer, J

AU - Amini, S

AU - Amir, T

AU - Anandarajah, C

AU - Anders, R

AU - Ansari, MH

AU - Appiah, K

AU - Atia, J

AU - Atkin, C

AU - Aujayeb, A

AU - Awad, EM

AU - Azab, MA

AU - Azam, MT

AU - Aziz, S

AU - Azzam, Y.

AU - Babar, Laxmi

AU - Babb, Laura

AU - Badh, Manpreet

AU - Baguneid, Clare

AU - Bailey, Emily

AU - Haunton, Victoria

PY - 2021/5/5

Y1 - 2021/5/5

N2 - 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.

AB - 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.

U2 - 10.1093/ageing/afab026

DO - 10.1093/ageing/afab026

M3 - Article

SN - 0002-0729

VL - 50

SP - 617

EP - 630

JO - Age and Ageing

JF - Age and Ageing

IS - 3

ER -

Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

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