Frailty Status and Outcomes of COVID-19 Patients Admitted to an Intensive Care Unit

Abstract

Frailty assessment using the Clinical Frailty Scale (CFS) has been incorporated into COVID-19 decision aids as frailty highlights risk of poor outcome which can guide future care (1, 2). The critical care patient population continues to trend towards a younger, fitter and less co-morbid population (3). Yet, COVID-19 is a disease that disproportionately effects the elderly; people aged over 65 years represent more than 50% of Intensive Care Unit (ICU) admissions and account for 80% of mortality (1). There are subsequent ethical considerations as to how resources were and continue to be allocated. For this reason, it is relevant we understand how frailty has impacted clinical decisions which may then drive improvements in future practice. Frailty has sustained relevance in a critical care environment with continual scarcity of resources (3). We undertook a service evaluation of the mortality and hospital outcomes of COVID-19 positive patients admitted to Ysbyty Gwynedd (YG) ICU from 01/03/2020 to 01/06/2022. We considered the effect of ICU patients’ pre-admission frailty on their subsequent outcomes as well as comparing how CFS scores of admitted patients changed over the evaluation period. Patients testing positive for COVID-19 that were admitted to ICU were the sole population of interest. Patients aged 18 or over were considered eligible for the evaluation and patients with suspected COVID-19 that tested negative were excluded. Retrospective data was sourced from the Intensive Care National Audit & Research Centre (ICNARC) database, handover notes and clinical files. CFS scores were used to dichotomise the cohort into two distinct groups; one group with CFS scores 1-4 was defined as fit or vulnerable and the second group scoring between 5-9 was defined as frail. Patients were then assigned a pandemic ‘wave’ based on their date of admission: admission between 01/03/2020 to 01/09/2020 were assigned ‘Wave 1’ and between 01/09/2020 to 01/06/2021 ‘Wave 2’. 72 COVID-19 patients were included in the service evaluation; 65% of patients were male and the mean age was 59 years (SD 13). The population had a mean ICNARC score © Serdi and Springer Nature Switzerland AG 2022