The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis
Author:
Bouwmans Pim12, Brandts Lloyd3, Hilbrands Luuk B4, Duivenvoorden Raphaël4, Vart Priya56, Franssen Casper F M6, Covic Adrian78, Islam Mahmud910, Rabaté Clémentine10, Jager Kitty J1112, Noordzij Marlies6, Gansevoort Ron T6, Hemmelder Marc H12, van der Net Jeroen B, Essig Marie, du Buf-Vereijken Peggy W G, van Ginneken Betty, Maas Nanda, van Jaarsveld Brigit C, Bemelman Frederike J, Klingenberg-Salahova Farah, Heenan-Vos Frederiek, Vervloet Marc G, Nurmohamed Azam, Vogt Liffert, Abramowicz Daniel, Verhofstede Sabine, Maoujoud Omar, Malfait Thomas, Fialova Jana, Melilli Edoardo, Favà Alexandre, Cruzado Josep M, Perez Nuria Montero, Lips Joy, Krepel Harmen, Adilovic Harun, Radulescu Daniela, Hengst Maaike, Konings Constantijn, Rydzewski Andrzej, Braconnier Philippe, Weis Daniel, Gellert Ryszard, Oliveira João, Alferes Daniela G, Zakharova Elena V, Ambühl Patrice Max, Guidotti Rebecca, Walker Andrea, Lepeytre Fanny, Rostoker Guy, Marques Sofia, Azasevac Tijana, Majstorovic Gordana Strazmester, Katicic Dajana, ten Dam Marc, Krüger Thilo, Brzosko Szymon, Liakopoulos Vassilios, Zanen Adriaan L, Logtenberg Susan J J, Fricke Lutz, Kuryata Olexandr, Slebe Jeroen J P, ElHafeez Samar Abd, Kemlin Delphine, van de Wetering Jacqueline, Reinders Marlies E J, Hesselink Dennis A, Kal-van Gestel Judith, Eiselt Jaromir, Kielberger Lukas, El-Wakil Hala S, Verhoeven Martine, Logan Ian, Canal Cristina, Facundo Carme, Ramos Ana M, Debska-Slizien Alicja, Veldhuizen Nicoline M H, Tigka Eirini, Konsta Maria Anna Polyzou, Panagoutsos Stylianos, Mallamaci Francesca, Postorino Adele, Cambareri Francesco, Matceac Irina, Nistor Ionut, Groeneveld J H M, Jousma Jolanda, van Buren Marjolijn, Diekmann Fritz, Oppenheimer Federico, Blasco Miquel, Pereira Tiago Assis, Santos Augusto Cesar S, Arias-Cabrales Carlos, Crespo Marta, Llinàs-Mallol Laura, Buxeda Anna, Tàrrega Carla Burballa, Redondo-Pachon Dolores, Jimenez Maria Dolores Arenas, Mendoza-Valderrey Alberto, Martins Ana Cristina, Mateus Catarina, Alvila Goncalo, Laranjinha Ivo, Hofstra Julia M, Siezenga Machiel A, Franco Antonio, Arroyo David, Castellano Sandra, Rodríguez-Ferrero Maria Luisa, Manzanos Sagrario Balda, Barrios R Haridian Sosa, Lemahieu Wim, Bartelet Karlijn, Dirim Ahmet Burak, Demir Erol, Sever Mehmet Sukru, Turkmen Aydin, Şafak Seda, Hollander Daan A M J, Büttner Stefan, de Vries Aiko P J, Meziyerh Soufian, van der Helm Danny, Mallat Marko, Bouwsma Hanneke, Sridharan Sivakumar, Petruliene Kristina, Maloney Sharon-Rose, Verberk Iris, van der Sande Frank M, Christiaans Maarten H L, N MohanKumar, Luca Marina Di, Tuğlular Serhan Z, Kramer Andrea B, Beerenhout Charles, Luik Peter T, Kerschbaum Julia, Tiefenthaler Martin, Watschinger Bruno, Adema Aaltje Y, Stepanov Vadim A, Zulkarnaev Alexey B, Turkmen Kultigin, Gandolfini Ilaria, Maggiore Umberto, Fliedner Anselm, Åsberg Anders, Mjoen Geir, Miyasato Hitoshi, de Fijter Carola W H, Mongera Nicola, Pini Stefano, de Biase Consuelo, Kerckhoffs Angele, van de Logt AnneEls, Maas Rutger, Lebedeva Olga, Lopez Veronica, Reichert Louis J M, Verhave Jacobien, Titov Denis, Parshina Ekaterina V, Zanoli Luca, Marcantoni Carmelita, van Kempen Gijs, van Gils-Verrij Liesbeth E A, Harty John C, Meurs Marleen, Myslak Marek, Battaglia Yuri, Lentini Paolo, den Deurwaarder Edwin, Stendahl Maria, Rahimzadeh Hormat, Schouten Marcel, Rychlik Ivan, Cabezas-Reina Carlos J, Roca Ana Maria, Nauta Ferdau, Sahin İdris, Goffin Eric, Kanaan Nada, Labriola Laura, Devresse Arnaud, Diaz-Mareque Anabel, Coca Armando, de Arriba Gabriel, Meijers Björn K I, Naesens Maarten, Kuypers Dirk, Desschans Bruno, Tonnerlier Annelies, Wissing Karl M, Dedinska Ivana, Pessolano Giuseppina, Malik Shafi, Dounousi Evangelia, Papachristou Evangelos, Berger Stefan P, Meijer Esther, Sanders Jan Stephan F, Özyilmaz Akin, Ponikvar Jadranka Buturović, Pernat Andreja Marn, Kovac Damjan, Arnol Miha, Ekart Robert, Abrahams Alferso C, Molenaar Femke M, van Zuilen Arjan D, Meijvis Sabine C A, Dolmans Helma, Tantisattamo Ekamol, Esposito Pasquale, Krzesinski Jean-Marie, Barahira Jean Damacène, Gallieni Maurizio, Martin-Moreno Paloma Leticia, Guglielmetti Gabriele, Guzzo Gabriella, Toapanta Nestor, Soler Maria Jose, Luik Antinus J, van Kuijk Willi H M, Stikkelbroeck Lonneke W H, Hermans Marc M H, Rimsevicius Laurynas, Righetti Marco, Heitink-ter Braak Nicole,
Affiliation:
1. Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center , Maastricht, The Netherlands 2. CARIM School for Cardiovascular Disease, University of Maastricht , Maastricht , The Netherlands 3. Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center , Maastricht , The Netherlands 4. Department of Nephrology, Radboud University Medical Center , Nijmegen , The Netherlands 5. Department of Internal Medicine, University Medical Center Groningen , Groningen , The Netherlands 6. Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen , Groningen , The Netherlands 7. Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania 8. Dr Ci Parhon Hospital , Iasi , Romania 9. Zonguldak Ataturk State Hospital , Zonguldak , Turkey 10. Claude Galien Hospital Ramsay Santé, Quincy-sous-Sénart , France 11. ERA Registry, Amsterdam UMC location University of Amsterdam, Medical Informatics , Amsterdam , The Netherlands 12. Amsterdam Public Health Research Institute, Quality of Care , Amsterdam , The Netherlands
Abstract
AbstractBackgroundSeveral 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.MethodsWe 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.ResultsA 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.ConclusionsFrail 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.
Funder
Dutch Kidney Foundation Baxter Sandoz
Publisher
Oxford University Press (OUP)
Subject
Transplantation,Nephrology
Cited by
3 articles.
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