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  • Mak, Jonathan K. L.Karolinska Institutet (author)

Two Years with COVID-19 : The Electronic Frailty Index Identifies High-Risk Patients in the Stockholm GeroCovid Study

  • Article/chapterEnglish2023

Publisher, publication year, extent ...

  • 2022-11-30
  • S. Karger,2023
  • electronicrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-502556
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-502556URI
  • https://doi.org/10.1159/000527206DOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:151424701URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Introduction: Frailty, a measure of biological aging, has been linked to worse COVID-19 outcomes. However, as the mortality differs across the COVID-19 waves, it is less clear whether a medical record-based electronic frailty index (eFI) that we have previously developed for older adults could be used for risk stratification in hospitalized COVID-19 patients. Objectives: The aim of the study was to examine the association of frailty with mortality, readmission, and length of stay in older COVID-19 patients and to compare the predictive accuracy of the eFI to other frailty and comorbidity measures. Methods: This was a retrospective cohort study using electronic health records (EHRs) from nine geriatric clinics in Stockholm, Sweden, comprising 3,980 COVID-19 patients (mean age 81.6 years) admitted between March 2020 and March 2022. Frailty was assessed using a 48-item eFI developed for Swedish geriatric patients, the Clinical Frailty Scale, and the Hospital Frailty Risk Score. Comorbidity was measured using the Charlson Comorbidity Index. We analyzed in-hospital mortality and 30-day readmission using logistic regression, 30-day and 6-month mortality using Cox regression, and the length of stay using linear regression. Predictive accuracy of the logistic regression and Cox models was evaluated by area under the receiver operating characteristic curve (AUC) and Harrell's C-statistic, respectively. Results: Across the study period, the in-hospital mortality rate decreased from 13.9% in the first wave to 3.6% in the latest (Omicron) wave. Controlling for age and sex, a 10% increment in the eFI was significantly associated with higher risks of in-hospital mortality (odds ratio = 2.95; 95% confidence interval = 2.42-3.62), 30-day mortality (hazard ratio [HR] = 2.39; 2.08-2.74), 6-month mortality (HR = 2.29; 2.04-2.56), and a longer length of stay (beta-coefficient = 2.00; 1.65-2.34) but not with 30-day readmission. The association between the eFI and in-hospital mortality remained robust across the waves, even after the vaccination rollout. Among all measures, the eFI had the best discrimination for in-hospital (AUC = 0.780), 30-day (Harrell's C = 0.733), and 6-month mortality (Harrell's C = 0.719). Conclusion: An eFI based on routinely collected EHRs can be applied in identifying high-risk older COVID-19 patients during the continuing pandemic.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Eriksdotter, MariaKarolinska Institutet (author)
  • Annetorp, MartinKarolinska Institutet (author)
  • Kuja-Halkola, RalfKarolinska Institutet (author)
  • Kananen, LauraKarolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ Tampere, Fac Social Sci, Hlth Sci, Tampere, Finland.;Univ Tampere, Gerontol Res Ctr GEREC, Tampere, Finland. (author)
  • Boström, Anne-MarieKarolinska Univ Hosp, Theme Inflammat & Aging, Huddinge, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Nursing, Stockholm, Sweden.;Stockholms Sjukhem, Res & Dev Unit, Stockholm, Sweden. (author)
  • Kivipelto, MiiaKarolinska Inst, Dept Neurobiol Care Sci & Soc, Div Clin Geriatr, Stockholm, Sweden.;Karolinska Univ Hosp, Theme Inflammat & Aging, Huddinge, Sweden. (author)
  • Metzner, CarinaKarolinska Inst, Dept Neurobiol Care Sci & Soc, Div Clin Geriatr, Stockholm, Sweden.;Karolinska Univ Hosp, Theme Inflammat & Aging, Huddinge, Sweden. (author)
  • Jerlardtz, Viktoria BäckJakobsbergsgeriatriken, Dept Geriatr Med, Stockholm, Sweden. (author)
  • Engström, MalinSabbatsbergsgeriatriken, Dept Geriatr Med, Stockholm, Sweden. (author)
  • Johnson, PeterCapio Geriatr Nacka AB, Dept Geriatr Med, Nacka, Sweden. (author)
  • Lundberg, Lars GöranDalengeriatriken Aleris Narsjukvard AB, Dept Geriatr Med, Stockholm, Sweden. (author)
  • Åkesson, ElisabetKarolinska Institutet (author)
  • Öberg, Carina SühlHandengeriatriken, Dept Geriatr Med, Aleris Narsjukvard AB, Stockholm, Sweden. (author)
  • Olsson, MariaCapio Geriatr Sollentuna, Dept Geriatr Med, Stockholm, Sweden.;Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden. (author)
  • Cederholm, TommyKarolinska Institutet (author)
  • Hägg, SaraKarolinska Institutet (author)
  • Religa, DorotaKarolinska Institutet (author)
  • Jylhävä, JuuliaKarolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ Tampere, Fac Social Sci, Hlth Sci, Tampere, Finland.;Univ Tampere, Gerontol Res Ctr GEREC, Tampere, Finland. (author)
  • Karolinska InstitutetKarolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ Tampere, Fac Social Sci, Hlth Sci, Tampere, Finland.;Univ Tampere, Gerontol Res Ctr GEREC, Tampere, Finland. (creator_code:org_t)

Related titles

  • In:Gerontology: S. Karger69:4, s. 396-4050304-324X1423-0003

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