Acute Crit Care.  2022 Aug;37(3):303-311. 10.4266/acc.2022.00017.

In-hospital mortality prediction using frailty scale and severity score in elderly patients with severe COVID-19

• Na YS
• Kim JH
• Baek MS
• Kim WY
• Baek AR
• Lee By
• Seong GM
• Lee SI

• KMID: 2535293
• DOI: http://doi.org/10.4266/acc.2022.00017

Abstract

Background
Elderly patients with coronavirus disease 2019 (COVID-19) have a high disease severity and mortality. However, the use of the frailty scale and severity score to predict in-hospital mortality in the elderly is not well established. Therefore, in this study, we investigated the use of these scores in COVID-19 cases in the elderly.
Methods
This multicenter retrospective study included severe COVID-19 patients admitted to seven hospitals in Republic of Korea from February 2020 to February 2021. We evaluated patients’ Acute Physiology and Chronic Health Evaluation (APACHE) II score; confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) score; modified early warning score (MEWS); Sequential Organ Failure Assessment (SOFA) score; clinical frailty scale (CFS) score; and Charlson comorbidity index (CCI). We evaluated the predictive value using receiver operating characteristic (ROC) curve analysis.
Results
The study included 318 elderly patients with severe COVID-19 of whom 237 (74.5%) were survivors and 81 (25.5%) were non-survivors. The non-survivor group was older and had more comorbidities than the survivor group. The CFS, CCI, APACHE II, SOFA, CURB-65, and MEWS scores were higher in the non-survivor group than in the survivor group. When analyzed using the ROC curve, SOFA score showed the best performance in predicting the prognosis of elderly patients (area under the curve=0.766, P<0.001). CFS and SOFA scores were associated with in-hospital mortality in the multivariate analysis.
Conclusions
The SOFA score is an efficient tool for assessing in-hospital mortality in elderly patients with severe COVID-19.

Keyword

COVID-19; critical care; elderly; mortality

Figure

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  Figure 1. Flowchart of patients. COVID-19: coronavirus disease 2019.

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  Figure 2. Receiver operating characteristic (ROC) curves of the clinical frailty scale (CFS), Charlson comorbidity index (CCI), Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), confusion, urea nitrogen, respiratory rate, blood pressure, 65 years of age and older (CURB-65) scores, and modified early warning score (MEWS) in predicting patients’ in-hospital mortality.

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