The impact of frailty on survival in elderly intensive care patients with COVID-19: the COVIP study
Authors: Jung Christian , Flaatten Hans , Fjølner Jesper , Bruno Raphael Romano , Wernly Bernhard , Artigas Antonio , Bollen Pinto Bernardo , Schefold Joerg C. , Wolff Georg , Kelm Malte , Beil Michael , Sviri Sigal , van Heerden Peter Vernon , Szczeklik Wojciech , Czuczwar Miroslaw , Elhadi Muhammed , Joannidis Michael , Oeyen Sandra , Zafeiridis Tilemachos , Marsh Brian , Andersen Finn H. , Moreno Rui , Cecconi Maurizio , Leaver Susannah , Boumendil Ariane , De Lange Dylan W. , Guidet Bertrand ,   COVIP study group, Flaatten Hans , Wernly Bernhard , Artigas Antonio , Beil Michael , Sviri Sigal , van Heerden Peter Vernon , Szczeklik Wojciech , Elhadi Muhammed , Zafeiridis Tilemachos , Moreno Rui , Cecconi Maurizio , Boumendil Ariane , Abosheaishaa Hazem Maarouf , Abualqumboz Enas M. Y. , Ahmed Abdullah Khudhur , Ahmed Hazem , Aidoni Zoi , Aldecoa Cesar , Alexandru Nica , Ali Yasmin Khairy NasrEldin Mohamed , Al-Sadawi Mohammed , Andersen Kasper , Andersen Finn H. , Assis Rui , Azab Mohammed A. , Azzam Ahmed Y. , Badawy Mohamed Raafat , Balleby Ida Riise , Barth Eberhard , Barth Eberhard , Ben-HAmouda Nawfel , Besch Guillaume , Besset Sebastien , Bjerregaard Anders Thais , Brix Helene , Bruno Raphael Romano , Brushoej Jens , Bundgaard Helle , Burtin Philippe , Caillard Anais , Canas-Perez Isabel , Charron Cyril , Chrisanthopoulou Evangelia , Comellini Vittoria , Cornet Alex , Cubero Patricia Jimeno , Czuczwar Miroslaw , Dauger Stéphane , Diaz-Rodriguez Cristina , Dieperink Willem , Dindane Zouhir , Djibré Michel , Dormans Tom , Dullenkopf Alexander , Dumas Guillaume , Elgazzar Yumna A. , Eller Philipp , Elsaka Ahmed , Evers Mirjam , Faltlhauser Andreas , Ferreira Aida Fernández , Fjølner Jesper , Fleury Yvan , Galbois Arnaud , Garcon Pierre , Garnier Marc , Gawda Ryszard , Ghannam Abdelilah , Goebel Ulrich , Gomà Gemma , Goncalves Bruno , Gordinho André , Groenendijk Martijn , Guerot Emmanuel , Guidet Bertrand , Gurjar Mohan , Haake Hendrik , Haas Lenneke , Habib Ayman Abdelmawgoad , Hahn Michael , Hansen Maria Aagaard , Hilles Momin Majed Yousuf , Hussein Aliae A. R. Mohamed , Iglesias David , Joannidis Michael , Jung Christian , Jurcisin Igor , Kabitz Hans-Joachim , Kelm Malte , Kindgen-Milles Detlef , Klimkiewicz Jakub , Kuhn Karl Friedrich , Kunstein Anselm , Kurt Muhammed , De Lange Dylan W. , Leaver Susannah , Lutz Matthias , Mahmoodpoor Ata , Maizel Julien , Marin Nathalie , Marsh Brian , Megarbane Buno , Mesotten Dieter , Meybohm Patrick , Meyer Christian , Mira Angela Prado , Namendys-Silva Silvio a , Nedergaard Helene Korvenius , Nseir Saad , Oeyen Sandra , Olasveengen Theresa , Oliveira Ana Isabel Pinho , Oziel Johanna , Papadogoulas Antonios , Perez-Torres David , Bollen Pinto Bernardo , Piton Gaël , Plantefeve Gaëtan , Poerner Tudor , Priego Jesús , Rabha Ahmed , Randerath Winfried , Raphaelen Jean-herlé , Reper Pascal , Rigaud Jean-Philippe , Rivera Susana Arias , Roberti Andrea , Romundstad Luis , Rovina Nikoletta , Salah Rehab , Saleh Mahmoud , Sancho Susana , de Lurdes Campos Santos Maria , Santos Henrique , Schaller Stefan , Schefold Joerg C. , Schuster Michael , Shala Gonxhe , Sjøbø Britt , Steiner Stephan , Strietzel Hans Frank , Sviri Sigal , Swinnen Walter , Tamayo-Lomas Luis , Tharwat Samar , Tomasa Teresa , Uhrenholt Stine , Vaissiere Marie , Valent Arnaud , Valette Xavier , Vanderlinden Thierry , Vázquez Eric Mayor , Villamayor Mercedes Ibarz , Villefrance Maja , Voigt Ingo , Wassim Kyrillos , Welte Martin , Wolff Georg , Wollborn Jakob , Zalba-Etayo Begoña , Zegers Marieke 
Published: April 2021

Abstract
Background
The COVID-19 pandemic has led highly developed healthcare systems to the brink of collapse due to the large numbers of patients being admitted into hospitals. One of the potential prognostic indicators in patients with COVID-19 is frailty. The degree of frailty could be used to assist both the triage into intensive care, and decisions regarding treatment limitations. Our study sought to determine the interaction of frailty and age in elderly COVID-19 ICU patients.

Methods
A prospective multicentre study of COVID-19 patients ≥ 70 years admitted to intensive care in 138 ICUs from 28 countries was conducted. The primary endpoint was 30-day mortality. Frailty was assessed using the clinical frailty scale. Additionally, comorbidities, management strategies and treatment limitations were recorded.

Results
The study included 1346 patients (28% female) with a median age of 75 years (IQR 72–78, range 70–96), 16.3% were older than 80 years, and 21% of the patients were frail. The overall survival at 30 days was 59% (95% CI 56–62), with 66% (63–69) in fit, 53% (47–61) in vulnerable and 41% (35–47) in frail patients (p < 0.001). In frail patients, there was no difference in 30-day survival between different age categories. Frailty was linked to an increased use of treatment limitations and less use of mechanical ventilation. In a model controlling for age, disease severity, sex, treatment limitations and comorbidities, frailty was independently associated with lower survival.

Conclusion
Frailty provides relevant prognostic information in elderly COVID-19 patients in addition to age and comorbidities.
Trial registration Clinicaltrials.gov: NCT04321265, registered 19 March 2020.