The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis
Authors: Bouwmans Pim , Brandts Lloyd , Hilbrands Luuk B , Duivenvoorden Raphaël , Vart Priya , Franssen Casper F M , Covic Adrian , Islam Mahmud , Rabaté Clémentine , Jager Kitty J , Noordzij Marlies , Gansevoort Ron T , Hemmelder Marc H ,   for the ERACODA collaborators, van der Net Jeroen B , Essig Marie , du Buf-Vereijken Peggy W G , van Ginneken Betty , Maas Nanda , van Jaarsveld Brigit C , Bemelman Frederike J , Klingenberg-Salahova Farah , Heenan-Vos Frederiek , Vervloet Marc G , Nurmohamed Azam , Vogt Liffert , Abramowicz Daniel , Verhofstede Sabine , Maoujoud Omar , Malfait Thomas , Fialova Jana , Melilli Edoardo , Favà Alexandre , Cruzado Josep M , Perez Nuria Montero , Lips Joy , Krepel Harmen , Adilovic Harun , Radulescu Daniela , Hengst Maaike , Konings Constantijn , Rydzewski Andrzej , Braconnier Philippe , Weis Daniel , Gellert Ryszard , Oliveira João , Alferes Daniela G , Zakharova Elena V , Ambühl Patrice Max , Guidotti Rebecca , Walker Andrea , Lepeytre Fanny , Rostoker Guy , Marques Sofia , Azasevac Tijana , Majstorovic Gordana Strazmester , Katicic Dajana , ten Dam Marc , Krüger Thilo , Brzosko Szymon , Liakopoulos Vassilios , Zanen Adriaan L , Logtenberg Susan J J , Fricke Lutz , Kuryata Olexandr , Slebe Jeroen J P , ElHafeez Samar Abd , Kemlin Delphine , van de Wetering Jacqueline , Reinders Marlies E J , Hesselink Dennis A , Kal-van Gestel Judith , Eiselt Jaromir , Kielberger Lukas , El-Wakil Hala S , Verhoeven Martine , Logan Ian , Canal Cristina , Facundo Carme , Ramos Ana M , Debska-Slizien Alicja , Veldhuizen Nicoline M H , Tigka Eirini , Konsta Maria Anna Polyzou , Panagoutsos Stylianos , Mallamaci Francesca , Postorino Adele , Cambareri Francesco , Matceac Irina , Nistor Ionut , Groeneveld J H M , Jousma Jolanda , van Buren Marjolijn , Diekmann Fritz , Oppenheimer Federico , Blasco Miquel , Pereira Tiago Assis , Santos Augusto Cesar S , Arias-Cabrales Carlos , Crespo Marta , Llinàs-Mallol Laura , Buxeda Anna , Tàrrega Carla Burballa , Redondo-Pachon Dolores , Jimenez Maria Dolores Arenas , Mendoza-Valderrey Alberto , Martins Ana Cristina , Mateus Catarina , Alvila Goncalo , Laranjinha Ivo , Hofstra Julia M , Siezenga Machiel A , Franco Antonio , Arroyo David , Castellano Sandra , Rodríguez-Ferrero Maria Luisa , Manzanos Sagrario Balda , Barrios R Haridian Sosa , Lemahieu Wim , Bartelet Karlijn , Dirim Ahmet Burak , Demir Erol , Sever Mehmet Sukru , Turkmen Aydin , Şafak Seda , Hollander Daan A M J , Büttner Stefan , de Vries Aiko P J , Meziyerh Soufian , van der Helm Danny , Mallat Marko , Bouwsma Hanneke , Sridharan Sivakumar , Petruliene Kristina , Maloney Sharon-Rose , Verberk Iris , van der Sande Frank M , Christiaans Maarten H L , N MohanKumar , Luca Marina Di , Tuğlular Serhan Z , Kramer Andrea B , Beerenhout Charles , Luik Peter T , Kerschbaum Julia , Tiefenthaler Martin , Watschinger Bruno , Adema Aaltje Y , Stepanov Vadim A , Zulkarnaev Alexey B , Turkmen Kultigin , Gandolfini Ilaria , Maggiore Umberto , Fliedner Anselm , Åsberg Anders , Mjoen Geir , Miyasato Hitoshi , de Fijter Carola W H , Mongera Nicola , Pini Stefano , de Biase Consuelo , Kerckhoffs Angele , van de Logt AnneEls , Maas Rutger , Lebedeva Olga , Lopez Veronica , Reichert Louis J M , Verhave Jacobien , Titov Denis , Parshina Ekaterina V , Zanoli Luca , Marcantoni Carmelita , van Kempen Gijs , van Gils-Verrij Liesbeth E A , Harty John C , Meurs Marleen , Myslak Marek , Battaglia Yuri , Lentini Paolo , den Deurwaarder Edwin , Stendahl Maria , Rahimzadeh Hormat , Schouten Marcel , Rychlik Ivan , Cabezas-Reina Carlos J , Roca Ana Maria , Nauta Ferdau , Sahin İdris , Goffin Eric , Kanaan Nada , Labriola Laura , Devresse Arnaud , Diaz-Mareque Anabel , Coca Armando , de Arriba Gabriel , Meijers Björn K I , Naesens Maarten , Kuypers Dirk , Desschans Bruno , Tonnerlier Annelies , Wissing Karl M , Dedinska Ivana , Pessolano Giuseppina , Malik Shafi , Dounousi Evangelia , Papachristou Evangelos , Berger Stefan P , Meijer Esther , Sanders Jan Stephan F , Özyilmaz Akin , Ponikvar Jadranka Buturović , Pernat Andreja Marn , Kovac Damjan , Arnol Miha , Ekart Robert , Abrahams Alferso C , Molenaar Femke M , van Zuilen Arjan D , Meijvis Sabine C A , Dolmans Helma , Tantisattamo Ekamol , Esposito Pasquale , Krzesinski Jean-Marie , Barahira Jean Damacène , Gallieni Maurizio , Martin-Moreno Paloma Leticia , Guglielmetti Gabriele , Guzzo Gabriella , Toapanta Nestor , Soler Maria Jose , Luik Antinus J , van Kuijk Willi H M , Stikkelbroeck Lonneke W H , Hermans Marc M H , Rimsevicius Laurynas , Righetti Marco , Heitink-ter Braak Nicole 
Published: August 2022

Background

Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (COVID-19) patients. This study evaluates the impact of CFS on intensive care unit (ICU) admission rate and hospital and ICU mortality rates in hospitalized dialysis patients with COVID-19.

Methods

We analysed data of dialysis patients diagnosed with COVID-19 from the European Renal Association COVID-19 Database. The primary outcome was ICU admission rate and secondary outcomes were hospital and ICU mortality until 3 months after COVID-19 diagnosis. Cox regression analyses were performed to assess associations between CFS and outcomes.

Results

A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients &gt;75 years of age with a CFS of 7–9 and highest (27%) in patients 65–75 years of age with a CFS of 5. A CFS of 7–9 was associated with a lower ICU admission rate than a CFS of 1–3 [relative risk 0.49 (95% confidence interval 0.27–0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients &gt;75 years of age with a CFS of 7–9 (69%). Only 9% of patients with a CFS ≥6 survived after ICU admission. After adjustment for age and sex, each CFS category ≥4 was associated with higher hospital and ICU mortality compared with a CFS of 1–3.

Conclusions

Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.