Cargando…

The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis

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...

Descripción completa

Detalles Bibliográficos
Autores principales: Bouwmans, Pim, Brandts, Lloyd, Hilbrands, Luuk B, Duivenvoorden, Raphaël, Vart, Priya, Franssen, Casper F M, Covic, Adrian, Islam, Mahmud, Rabaté, Clémentine, Jager, Kitty J, Noordzij, Marlies, Gansevoort, Ron T, Hemmelder, Marc H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9452166/
https://www.ncbi.nlm.nih.gov/pubmed/36002034
http://dx.doi.org/10.1093/ndt/gfac246
_version_ 1784784871392018432
author Bouwmans, Pim
Brandts, Lloyd
Hilbrands, Luuk B
Duivenvoorden, Raphaël
Vart, Priya
Franssen, Casper F M
Covic, Adrian
Islam, Mahmud
Rabaté, Clémentine
Jager, Kitty J
Noordzij, Marlies
Gansevoort, Ron T
Hemmelder, Marc H
author_facet Bouwmans, Pim
Brandts, Lloyd
Hilbrands, Luuk B
Duivenvoorden, Raphaël
Vart, Priya
Franssen, Casper F M
Covic, Adrian
Islam, Mahmud
Rabaté, Clémentine
Jager, Kitty J
Noordzij, Marlies
Gansevoort, Ron T
Hemmelder, Marc H
author_sort Bouwmans, Pim
collection PubMed
description 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.
format Online
Article
Text
id pubmed-9452166
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-94521662022-09-09 The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis Bouwmans, Pim Brandts, Lloyd Hilbrands, Luuk B Duivenvoorden, Raphaël Vart, Priya Franssen, Casper F M Covic, Adrian Islam, Mahmud Rabaté, Clémentine Jager, Kitty J Noordzij, Marlies Gansevoort, Ron T Hemmelder, Marc H Nephrol Dial Transplant Original Article 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. Oxford University Press 2022-08-24 /pmc/articles/PMC9452166/ /pubmed/36002034 http://dx.doi.org/10.1093/ndt/gfac246 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the ERA. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Original Article
Bouwmans, Pim
Brandts, Lloyd
Hilbrands, Luuk B
Duivenvoorden, Raphaël
Vart, Priya
Franssen, Casper F M
Covic, Adrian
Islam, Mahmud
Rabaté, Clémentine
Jager, Kitty J
Noordzij, Marlies
Gansevoort, Ron T
Hemmelder, Marc H
The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis
title The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis
title_full The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis
title_fullStr The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis
title_full_unstemmed The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis
title_short The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis
title_sort clinical frailty scale as a triage tool for icu admission of dialysis patients with covid-19: an eracoda analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9452166/
https://www.ncbi.nlm.nih.gov/pubmed/36002034
http://dx.doi.org/10.1093/ndt/gfac246
work_keys_str_mv AT bouwmanspim theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT brandtslloyd theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT hilbrandsluukb theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT duivenvoordenraphael theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT vartpriya theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT franssencasperfm theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT covicadrian theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT islammahmud theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT rabateclementine theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT jagerkittyj theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT noordzijmarlies theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT gansevoortront theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT hemmeldermarch theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT theclinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT bouwmanspim clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT brandtslloyd clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT hilbrandsluukb clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT duivenvoordenraphael clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT vartpriya clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT franssencasperfm clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT covicadrian clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT islammahmud clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT rabateclementine clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT jagerkittyj clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT noordzijmarlies clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT gansevoortront clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT hemmeldermarch clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis
AT clinicalfrailtyscaleasatriagetoolforicuadmissionofdialysispatientswithcovid19aneracodaanalysis