Risk factors for severe COVID-19 disease and death in patients aged 70 and over: a retrospective observational cohort study

Abstract

Abstract Background: The COVID-19 pandemic resulted in a rapid reorganization of hospital care. In our hospital, the Clinical Frailty Scale (CFS) was introduced as a result of these reorganizations. A retrospective analysis was performed to investigate whether typical geriatric risk factors, such as frailty, comorbidity, living situation and cognitive decline, have added value compared to conventional risk factors in predicting severe COVID-19 disease and in-hospital death. Methods: In patients aged 70 years and over, an online geriatric assessment questionnaire was launched, from which the CFS was scored by the geriatrics team. Additional clinical data were collected from the electronic medical records. Baseline characteristics were described with descriptive statistics. Associations were analysed with uni- and multivariable analyses. Results: One hundred and five patients were included, median age 82 years. CFS scores were 1-4 in 43, 5-6 in 45, and 7-9 in 17 patients. Univariable analysis showed age, CFS, Charlson Comorbidity Index (CCI), age-adjusted CCI and cognitive decline associated with in-hospital mortality. Male gender, obesity, cardiovascular disease, chronic pulmonary disease, diabetes, cancer and hypertension were not significantly associated. In multivariable analysis, CFS and cognitive decline were independent predictors for in-hospital mortality. Chronic obstructive pulmonary disease, presence of respiratory symptoms on admission and male gender were associated with severe disease (univariable analysis). Conclusion: Through action of the geriatrics team at the time of rapid changes in the hospital, the frailty concept was introduced in the COVID-19 hospitalization units. A retrospective analysis shows that geriatric risk factors exceed conventional risk factors for predicting in-hospital mortality.