Müller, Ilena; Mancinetti, Marco; Renner, Anja; Bridevaux, Pierre-Olivier; Brutsche, Martin H; Clarenbach, Christian; Garzoni, Christian; Lenoir, Alexandra; Naccini, Bruno; Ott, Sebastian; Piquilloud, Lise; Prella, Maura; Que, Yok-Ai; Soccal, Paola Marina; von Garnier, Christophe; Geiser, Thomas K; Funke-Chambour, Manuela; Guler, Sabina (2022). Frailty assessment for COVID-19 follow-up: a prospective cohort study. BMJ Open Respiratory Research, 9(1) BMJ Publishing Group: Open Access 10.1136/bmjresp-2022-001227
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BACKGROUND
The Clinical Frailty Scale (CFS) is increasingly used for clinical decision making in acute care but little is known about frailty after COVID-19.
OBJECTIVES
To investigate frailty and the CFS for post-COVID-19 follow-up.
METHODS
This prospective multicentre cohort study included COVID-19 survivors aged ≥50 years presenting for a follow-up visit ≥3 months after the acute illness. Nine centres retrospectively collected pre-COVID-19 CFS and prospectively CFS at follow-up. Three centres completed the Frailty Index (FI), the short physical performance battery (SPPB), 30 s sit-to-stand test and handgrip strength measurements. Mixed effect logistic regression models accounting for repeated measurements and potential confounders were used to investigate factors associated with post-COVID-19 CFS. Criterion and construct validity were determined by correlating the CFS to other concurrently assessed frailty measurements and measures of respiratory impairment, respectively.
RESULTS
Of the 288 participants 65% were men, mean (SD) age was 65.1 (9) years. Median (IQR) CFS at follow-up was 3 (2-3), 21% were vulnerable or frail (CFS ≥4). The CFS was responsive to change, correlated with the FI (r=0.69, p<0.001), the SPPB score (r=-0.48, p<0.001) (criterion validity) and with the St George's Respiratory Questionnaire score (r=0.59, p<0.001), forced vital capacity %-predicted (r=-0.25, p<0.001), 6 min walk distance (r=-0.39, p<0.001) and modified Medical Research Council (mMRC) (r=0.59, p<0.001). Dyspnoea was significantly associated with a higher odds for vulnerability/frailty (per one mMRC adjusted OR 2.01 (95% CI 1.13 to 3.58), p=0.02).
CONCLUSIONS
The CFS significantly increases with COVID-19, and dyspnoea is an important risk factor for post-COVID-19 frailty and should be addressed thoroughly.