The Impact of Frailty, Oropharyngeal Dysphagia and Malnutrition on Mortality in Older Patients Hospitalized for Covid-19.

COVID-19 hospital mortality is higher among older patients through as yet little-known factors. We aimed to assess the effect of frailty (FR), oropharyngeal dysphagia (OD) and malnutrition (MN) on mortality in hospitalized COVID-19 older patients. Prospective cohort study of older patients (>70 years) with COVID-19 admitted to a general hospital from April 2020 to January 2021. Patients were evaluated on admission, discharge and at 1- and 3-months follow up. FR was assessed with FRAIL-VIG, OD with Volume-Viscosity Swallowing Test and MN with GLIM criteria. Clinical characteristics and outcomes, including intra-hospital, 1- and 3-month mortality, were analyzed. 258 patients were included (82.5±7.6 years; 58.9% women); 66.7% had FR (mild 28.7%, moderate 27.1% and severe 10.9%); 65.4%, OD and 50.6%, MN. OD prevalence increased from non-FR patients through the severity levels of FR: mild, moderate and severe (29.8%, 71.6%, 90.0%, 96.2%; p<0.0001, respectively), but not that of MN (50.6%, 47.1%, 52.5%, 56.0%). Mortality over the whole study significantly increased across FR categories (9.3% non-FR; 23.0% mild; 35.7% moderate; 75.0% severe; p<.001). Functionality (Barthel pre-admission, HR=0.983, CI-95%:0.973-0.993; p=0.001), OD (HR=2.953, CI-95%:0.970-8.989; p=0.057) and MN (HR=4.279, CI-95%:1.658-11.049; p=0.003) were independent risk factors for intra-hospital mortality. FR, OD and MN are highly prevalent conditions in older patients hospitalized with COVID-19. Functionality, OD and MN were independent risk factors for intra-hospital mortality.

[1]  J. Ramos-Rincón,et al.  Association between Clinical Frailty Scale (CFS) and clinical presentation and outcomes in older inpatients with COVID-19 , 2023, BMC Geriatrics.

[2]  K. Chou,et al.  Prevalence of oropharyngeal dysphagia and risk of mortality among hospitalized COVID-19 patients: A meta-analysis , 2022, Journal of global health.

[3]  P. Clavé,et al.  A Systematic and Universal Artificial Intelligence Screening Method for Oropharyngeal Dysphagia: Improving Diagnosis Through Risk Management , 2022, Dysphagia.

[4]  P. Clavé,et al.  A Comparative Study between the Three Waves of the Pandemic on the Prevalence of Oropharyngeal Dysphagia and Malnutrition among Hospitalized Patients with COVID-19 , 2022, Nutrients.

[5]  M. Tresoldi,et al.  Prevalence of Long COVID-19 Symptoms After Hospital Discharge in Frail and Robust Patients , 2022, Frontiers in medicine.

[6]  K. Bosma,et al.  Clinical characteristics, multiorgan dysfunction and outcomes of patients with COVID-19: a prospective case series , 2022, CMAJ open.

[7]  F. Voltarelli,et al.  COVID‐19 mortality and its predictors in the elderly: A systematic review , 2022, Health science reports.

[8]  P. Wischmeyer,et al.  Recovery Focused Nutritional Therapy across the Continuum of Care: Learning from COVID-19 , 2021, Nutrients.

[9]  V. Arreola,et al.  A Systematic and a Scoping Review on the Psychometrics and Clinical Utility of the Volume-Viscosity Swallow Test (V-VST) in the Clinical Screening and Assessment of Oropharyngeal Dysphagia , 2021, Foods.

[10]  C. Finizia,et al.  Characterization of dysphagia and laryngeal findings in COVID-19 patients treated in the ICU—An observational clinical study , 2021, PloS one.

[11]  V. Arreola,et al.  COVID-19 is associated with oropharyngeal dysphagia and malnutrition in hospitalized patients during the spring 2020 wave of the pandemic , 2021, Clinical Nutrition.

[12]  S. Santaeugènia,et al.  Reliability, Validity, and Feasibility of the Frail-VIG Index , 2021, International journal of environmental research and public health.

[13]  J. Wang,et al.  The Impact of Frailty on COVID-19 Outcomes: A Systematic Review and Meta-analysis of 16 Cohort Studies , 2021, The journal of nutrition, health & aging.

[14]  Pilar Ricart Martí,et al.  Dysphagia and mechanical ventilation in SARS-COV-2 pneumonia: It's real , 2021, Clinical Nutrition.

[15]  S. Anker,et al.  Weight loss, malnutrition, and cachexia in COVID‐19: facts and numbers , 2020, Journal of cachexia, sarcopenia and muscle.

[16]  R. Pranata,et al.  Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis , 2020, Archives of Gerontology and Geriatrics.

[17]  Jing Cao,et al.  Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis , 2020, BMC Geriatrics.

[18]  M. Brodsky,et al.  Potential Influence of Olfactory, Gustatory, and Pharyngolaryngeal Sensory Dysfunctions on Swallowing Physiology in COVID-19 , 2020, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[19]  D. Prytherch,et al.  The performance of the National Early Warning Score and National Early Warning Score 2 in hospitalised patients infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) , 2020, Resuscitation.

[20]  D. Cummings,et al.  Age-specific mortality and immunity patterns of SARS-CoV-2 , 2020, Nature.

[21]  S. Hamdy,et al.  ESSD Commentary on Dysphagia Management During COVID Pandemia , 2020, Dysphagia.

[22]  A. Ceccarelli,et al.  Predictive Accuracy of COVID-19 World Health Organization (WHO) Severity Classification and Comparison with a Bayesian-Method-Based Severity Score (EPI-SCORE) , 2020, Pathogens.

[23]  V. Arora,et al.  Morbidity and mortality trends of Covid 19 in top 10 countries , 2020, Indian Journal of Tuberculosis.

[24]  L. Rodríguez-Mañas,et al.  Rapid Assessment at Hospital Admission of Mortality Risk From COVID-19: The Role of Functional Status , 2020, Journal of the American Medical Directors Association.

[25]  I. Tanboğa,et al.  The role of Frailty on Adverse Outcomes Among Older Patients with COVID-19 , 2020, Journal of Infection.

[26]  J. Carretero Gómez,et al.  La inflamación, la desnutrición y la infección por SARS-CoV-2: una combinación nefasta , 2020, Revista Clínica Española.

[27]  J. Jiménez,et al.  Comorbidity and prognostic factors on admission in a COVID-19 cohort of a general hospital , 2020, Revista Clínica Española (English Edition).

[28]  Yuxin Shi,et al.  Evaluation of Nutrition Risk and Its Association With Mortality Risk in Severely and Critically Ill COVID‐19 Patients , 2020, JPEN. Journal of parenteral and enteral nutrition.

[29]  T. Warnecke,et al.  Dysphagia in COVID‐19 –multilevel damage to the swallowing network? , 2020, European journal of neurology.

[30]  Shaowen Zhang,et al.  Clinical significance of nutritional risk screening for older adult patients with COVID-19 , 2020, European Journal of Clinical Nutrition.

[31]  Eleanor M. Rees,et al.  COVID-19 length of hospital stay: a systematic review and data synthesis , 2020, BMC Medicine.

[32]  Stephan C. Bischoff,et al.  ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection , 2020, Clinical Nutrition.

[33]  R. Comet,et al.  Assessing the strengths and weaknesses of the Clinical Frailty Scale through correlation with a frailty index , 2020, Aging Clinical and Experimental Research.

[34]  B. Silke,et al.  Comparative influence of Acute Illness Severity and comorbidity on mortality. , 2019, European journal of internal medicine.

[35]  M. Inzitari,et al.  Frail-VIG index: a concise frailty evaluation tool for rapid geriatric assessment , 2018, BMC Geriatrics.

[36]  P. Clavé,et al.  Diagnosis and Management of Oropharyngeal Dysphagia Among Older Persons, State of the Art. , 2017, Journal of the American Medical Directors Association.

[37]  Matteo Cesari,et al.  Frailty consensus: a call to action. , 2013, Journal of the American Medical Directors Association.

[38]  Viridiana Arreola,et al.  Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. , 2008, Clinical nutrition.

[39]  L. Fried,et al.  Frailty, hospitalization, and progression of disability in a cohort of disabled older women. , 2005, The American journal of medicine.

[40]  I. McDowell,et al.  A global clinical measure of fitness and frailty in elderly people , 2005, Canadian Medical Association Journal.

[41]  Aaron Aragaki,et al.  Frailty: Emergence and Consequences in Women Aged 65 and Older in the Women's Health Initiative Observational Study , 2005, Journal of the American Geriatrics Society.

[42]  P. Clavé,et al.  Effect of a Minimal-Massive Intervention in Hospitalized Older Patients with Oropharyngeal Dysphagia: A Proof of Concept Study , 2018, The journal of nutrition, health & aging.

[43]  C. Mackenzie,et al.  A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. , 1987, Journal of chronic diseases.