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      Association between a Frailty Index from Common Laboratory Values and Vital Signs (FI-LAB) and Hospital and Post-Hospital Outcomes in Veterans with COVID-19 Infection

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          Abstract

          Objectives

          Determine the association of higher FI-LAB scores, derived from common laboratory values and vital signs, with hospital and post-hospital outcomes in Veterans hospitalized with COVID-19 infection.

          Design, Setting, and Participants

          A retrospective, multicenter, cohort study of 7 Veterans Health Administration (VHA) medical centers in Florida and Puerto Rico. Patients aged 18 years and older hospitalized with COVID-19 and followed for up to 1 year post discharge or until death.

          Clinical Frailty Measure: FI-LAB. Main Outcomes and Measures

          Hospital and post-hospital outcomes.

          Results

          Of the 671 eligible patients, 615 (91.5%) patients were included (mean [SD] age, 66.1 [14.8] years; 577 men [93.8%]; median stay, 8 days [IQR:3-15]. There were sixty-one in-hospital deaths. Veterans in the moderate and high FI-LAB groups had a higher proportion of inpatient mortality (13.3% and 20.6%, respectively) than the low group (4.1%), p <0.001. Moderate and high FI-LAB scores were associated with greater inpatient mortality when compared to the low group, OR:3.22 (95%CI:1.59-6.54), p=.001 and 6.05 (95%CI:2.48-14.74), p<0.001, respectively. Compared with low FI-LAB scores, moderate and high scores were also associated with prolonged length of stay, intensive care unit (ICU) admission, and transfer.

          Conclusions and Relevance

          In this study of patients admitted to 7 VHA Hospitals during the first surge of the pandemic, higher FI-LAB scores were associated with higher in-hospital mortality and other in-hospital outcomes; FI-LAB can serve as a validated, rapid, feasible, and objective frailty tool in hospitalized adults with COVID-19 that can aid clinical care.

          Electronic Supplementary Material

          Supplementary material is available for this article at 10.1007/s12603-023-1886-0 and is accessible for authorized users.

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          Most cited references41

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          Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

          Nanshan Chen, Min Zhou, Xuan Dong … (2022)
          Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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            Frailty in elderly people

            Andrew B. Clegg, John Young, Steve Iliffe … (2013)
            Frailty is the most problematic expression of population ageing. It is a state of vulnerability to poor resolution of homoeostasis after a stressor event and is a consequence of cumulative decline in many physiological systems during a lifetime. This cumulative decline depletes homoeostatic reserves until minor stressor events trigger disproportionate changes in health status. In landmark studies, investigators have developed valid models of frailty and these models have allowed epidemiological investigations that show the association between frailty and adverse health outcomes. We need to develop more efficient methods to detect frailty and measure its severity in routine clinical practice, especially methods that are useful for primary care. Such progress would greatly inform the appropriate selection of elderly people for invasive procedures or drug treatments and would be the basis for a shift in the care of frail elderly people towards more appropriate goal-directed care. Copyright © 2013 Elsevier Ltd. All rights reserved.
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              A global clinical measure of fitness and frailty in elderly people.

              Kenneth Rockwood, Xiaowei Song, Chris MacKnight … (2005)
              There is no single generally accepted clinical definition of frailty. Previously developed tools to assess frailty that have been shown to be predictive of death or need for entry into an institutional facility have not gained acceptance among practising clinicians. We aimed to develop a tool that would be both predictive and easy to use. We developed the 7-point Clinical Frailty Scale and applied it and other established tools that measure frailty to 2305 elderly patients who participated in the second stage of the Canadian Study of Health and Aging (CSHA). We followed this cohort prospectively; after 5 years, we determined the ability of the Clinical Frailty Scale to predict death or need for institutional care, and correlated the results with those obtained from other established tools. The CSHA Clinical Frailty Scale was highly correlated (r = 0.80) with the Frailty Index. Each 1-category increment of our scale significantly increased the medium-term risks of death (21.2% within about 70 mo, 95% confidence interval [CI] 12.5%-30.6%) and entry into an institution (23.9%, 95% CI 8.8%-41.2%) in multivariable models that adjusted for age, sex and education. Analyses of receiver operating characteristic curves showed that our Clinical Frailty Scale performed better than measures of cognition, function or comorbidity in assessing risk for death (area under the curve 0.77 for 18-month and 0.70 for 70-month mortality). Frailty is a valid and clinically important construct that is recognizable by physicians. Clinical judgments about frailty can yield useful predictive information.
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                Author and article information

                Contributors
                Natasha Melo Resendes:
                ORCID: https://orcid.org/0000-0003-2867-7227
                natasha.resendes@va.gov
                Journal
                Journal ID (nlm-ta): J Nutr Health Aging
                Journal ID (iso-abbrev): J Nutr Health Aging
                Title: The Journal of Nutrition, Health & Aging
                Publisher: Springer Paris (Paris )
                ISSN (Print): 1279-7707
                ISSN (Electronic): 1760-4788
                Publication date (Electronic): 2 February 2023
                Pages: 1-7
                Affiliations
                [1 ]GRID grid.511190.d, ISNI 0000 0004 7648 112X, Miami VA (Veterans Administration) Healthcare System Geriatric Research, Education and Clinical Center (GRECC), ; Miami, Florida USA
                [2 ]GRID grid.26790.3a, ISNI 0000 0004 1936 8606, Dept. of Medicine, , University of Miami Miller School of Medicine, ; Miami, Florida USA
                [3 ]GRID grid.413948.3, ISNI 0000 0004 0419 3727, Miami VA Healthcare System, Geriatric Research, Education and Clinical Center (GRECC), GRECC (11GRC), Bruce W. Carter Miami VAMC, ; 1201 NW 16th Street, Miami, Florida 33125 USA
                Author information
                https://orcid.org/0000-0003-2867-7227
                Article
                Publisher ID: 1886
                DOI: 10.1007/s12603-023-1886-0
                PMC ID: 9893965
                SO-VID: c4d28be3-3c9b-4514-99d5-543893d4ac64
                Copyright © © Serdi and Springer-Verlag International SAS, part of Springer Nature 2023
                License:

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                Date received : 3 November 2022
                Date accepted : 9 January 2023
                Categories
                Subject: Original Research

                Keywords: frailty,fi-lab,mortality,covid-19,inpatient,veterans
                Data availability:
                Keywords: frailty, fi-lab, mortality, covid-19, inpatient, veterans

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