TY - JOUR
T1 - The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19
T2 - an ERACODA analysis
AU - Bouwmans, Pim
AU - Brandts, Lloyd
AU - Hilbrands, Luuk B
AU - Duivenvoorden, Raphaël
AU - Vart, Priya
AU - Franssen, Casper F M
AU - Covic, Adrian
AU - Islam, Mahmud
AU - Rabaté, Clémentine
AU - Jager, Kitty J
AU - Noordzij, Marlies
AU - Gansevoort, Ron T
AU - Hemmelder, Marc H
AU - ERACODA Collaborators
AU - Nurmohamed, SA
AU - Study group members AMC, null
AU - Vogt, L
AU - Bemelman, Frederike J.
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.
PY - 2022/10/19
Y1 - 2022/10/19
N2 - BACKGROUND: Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (COVID-19) patients. This study evaluates the impact of CFS on intensive care unit (ICU) admission rate and hospital and ICU mortality rates in hospitalized dialysis patients with COVID-19.METHODS: We analysed data of dialysis patients diagnosed with COVID-19 from the European Renal Association COVID-19 Database. The primary outcome was ICU admission rate and secondary outcomes were hospital and ICU mortality until 3 months after COVID-19 diagnosis. Cox regression analyses were performed to assess associations between CFS and outcomes.RESULTS: A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7-9 and highest (27%) in patients 65-75 years of age with a CFS of 5. A CFS of 7-9 was associated with a lower ICU admission rate than a CFS of 1-3 [relative risk 0.49 (95% confidence interval 0.27-0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7-9 (69%). Only 9% of patients with a CFS ≥6 survived after ICU admission. After adjustment for age and sex, each CFS category ≥4 was associated with higher hospital and ICU mortality compared with a CFS of 1-3.CONCLUSIONS: Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.
AB - BACKGROUND: Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (COVID-19) patients. This study evaluates the impact of CFS on intensive care unit (ICU) admission rate and hospital and ICU mortality rates in hospitalized dialysis patients with COVID-19.METHODS: We analysed data of dialysis patients diagnosed with COVID-19 from the European Renal Association COVID-19 Database. The primary outcome was ICU admission rate and secondary outcomes were hospital and ICU mortality until 3 months after COVID-19 diagnosis. Cox regression analyses were performed to assess associations between CFS and outcomes.RESULTS: A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7-9 and highest (27%) in patients 65-75 years of age with a CFS of 5. A CFS of 7-9 was associated with a lower ICU admission rate than a CFS of 1-3 [relative risk 0.49 (95% confidence interval 0.27-0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7-9 (69%). Only 9% of patients with a CFS ≥6 survived after ICU admission. After adjustment for age and sex, each CFS category ≥4 was associated with higher hospital and ICU mortality compared with a CFS of 1-3.CONCLUSIONS: Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.
KW - Aged
KW - COVID-19 Testing
KW - COVID-19/diagnosis
KW - Fatigue Syndrome, Chronic/complications
KW - Frailty/diagnosis
KW - Humans
KW - Intensive Care Units
KW - Renal Dialysis
KW - Triage
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85149279015&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36002034
U2 - https://doi.org/10.1093/ndt/gfac246
DO - https://doi.org/10.1093/ndt/gfac246
M3 - Article
C2 - 36002034
SN - 0931-0509
VL - 37
SP - 2264
EP - 2274
JO - Nephrology, dialysis, transplantation
JF - Nephrology, dialysis, transplantation
IS - 11
ER -