Impact of frailty on long-term survival in patients discharged alive from hospital after an ICU admission with COVID-19

Ashwin Subramaniam; Ryan Ruiyang Ling; David Pilcher

doi:10.1016/j.ccrj.2023.11.001

Impact of frailty on long-term survival in patients discharged alive from hospital after an ICU admission with COVID-19

Crit Care Resusc. 2023 Dec 14;26(1):16-23. doi: 10.1016/j.ccrj.2023.11.001. eCollection 2024 Mar.

Authors

Ashwin Subramaniam^{1

2

3

4}, Ryan Ruiyang Ling⁵, David Pilcher^{4

6

7}

Affiliations

¹ Department of Intensive Care, Peninsula Health, Frankston, Victoria, Australia.
² Department of Intensive Care, Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia.
³ Peninsula Clinical School, Monash University, Frankston, Victoria, Australia.
⁴ Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁵ Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
⁶ Department of Intensive Care, Alfred Hospital, Melbourne, Victoria, Australia.
⁷ Centre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Victoria, Australia.

Abstract

Objective: Though frailty is associated with mortality, its impact on long-term survival after an ICU admission with COVID-19 is unclear. We aimed to investigate the association between frailty and long-term survival in patients after an ICU admission with COVID-19.

Design setting and participants: This registry-based multicentre, retrospective, cohort study included all patients ≥16 years discharged alive from the hospital following an ICU admission with COVID-19 and documented clinical frailty scale (CFS). Data from 118 ICUs between 01/01/2020 through 31/12/2020 in New Zealand and 31/12/2021 in Australia were reported in the Australian and New Zealand Intensive Care Society Adult Patient Database. The patients were categorised as 'not frail' (CFS 1-3), 'mildly frail' (CFS 4-5) and 'moderately-to-severely frail' (CFS 6-8).

Main outcome measures: The primary outcome was survival time up to two years, which we analysed using Cox regression models.

Results: We included 4028 patients with COVID-19 in the final analysis. 'Moderately-to-severely frail' patients were older (66.6 [56.3-75.8] vs. 69.9 [60.3-78.1]; p < 0.001) than those without frailty (median [interquartile range] 53.0 [40.1-64.6]), had higher sequential organ failure assessment scores (p < 0.001), and less likely to receive mechanical ventilation (p < 0.001) than patients without frailty or mild frailty. After adjusting for confounders, patients with mild frailty (adjusted hazards ratio: 2.31, 95%-CI: 1.75-3.05) and moderate-to-severe frailty (adjusted hazards ratio: 2.54, 95%-CI: 1.89-3.42) had higher mortality rates than those without frailty.

Conclusions: Frailty was independently associated with shorter survival times to two years in patients with severe COVID-19 in ANZ following hospital discharge. Recognising frailty provides individualised patient intervention in those with frailty admitted to ICUs with severe COVID-19.

Clinical trial registration: Not applicable.

Keywords: ANZICS adult patient database; CFS; COVID-19; Clinical frailty scale; Frailty; Long-term survival.