Predicting Mortality Risk in Older Hospitalized Persons With COVID-19: A Comparison of the COVID-19 Mortality Risk Score with Frailty and Disability.
Carlo Fumagalli, Andrea Ungar, Renzo Rozzini and 15 others
PMID 34334160WHAT IT FOUND
Adding pre-admission disability and frailty scores to a standard COVID-19 mortality risk score improved prediction accuracy for older hospitalized patients.
Functional status two weeks before admission was independently associated with survival, suggesting these factors should be routinely assessed.
Key findings
01A higher Barthel Index (indicating less disability) and the absence of frailty were independently associated with better survival outcomes in older patients with COVID-19.
02Combining the COVID-19 Mortality Risk Score with functional (Barthel Index) and frailty (mFI) assessments increased predictive accuracy for in-hospital mortality from 0.81 to 0.87.
03Almost half of the patients aged 75 or older who were hospitalized with COVID-19 died during their stay.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for RNs
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What it does not show
The observational design prevents causal conclusions about clinical determinants of mortality. Some laboratory parameters were not collected for all patients, potentially biasing the sample. Frailty was assessed using the modified Frailty Index (mFI) rather than the physical phenotype (Fried), which was difficult to derive in acute hospital patients. Therapeutic strategies were adapted over time during the pandemic, which may confound associations with treatment.
The easy way to misread this
Do not interpret the improved predictive accuracy of the combined score as evidence that interventions targeting these specific risk factors will improve survival. The study identifies associations, not causal effects of treatments.