COVID-19 Associated Outcomes of Critical Illness in Patients with Frailty
Principal Investigators: Oleksa G, Rolfson Darryl, Bagshaw, Sean M, Montgomery, Carmel: University of Alberta
The pandemic severe acute respiratory syndrome coronavirus-2 and resulting coronavirus disease (COVID-19) appears to disproportionately infect older patients and those with greater co-morbid disease, resulting in elevated risk of critical illness. Frailty can be measured in critical care settings with user-friendly, validated instruments. However, as there has not been any systematic evaluation of frailty in COVID-19 patients, it is not yet known whether frailty assessment may provide important prognostic information for patients presenting with severe COVID-19 symptoms, their family members and healthcare professionals.
In Alberta, frailty has been broadly studied and found to be present in 23% of community dwelling seniors, associated with advancing age and increased emergency department visits, acute hospitalizations, long term institutionalization and death. In Alberta assisted living settings, the proportion of frail is higher at 48% with similar adverse outcomes. In ICU, frail patients comprise 28% of all adult admissions, and is associated with higher hospital mortality (23% vs 9%) and longer hospital stay (16 vs 10 days), compared to non-frail patients. Based on international reports of COVID-19 outcomes, ICU mortality in older patients receiving mechanical ventilation could reach 62% or higher given that reports are coming from hospitals with COVID-19 patients who remain in ICU.
For vulnerable patients with COVID-19, frailty information adds context to discussions about advance care plans and goals of care in both pre-hospital and hospital settings. Frailty assessment can inform patient-centred care planning discussions that consider an individual’s acute illness and potential need for invasive interventions, to confirm expectations for a clinical course of ICU treatment. Frailty has been shown to be superior to chronological age alone, adding incremental value for prognostication and could be a consideration in triage scoring and decision algorithms associated with pandemic surge.
The specific risk associated with frailty in ICU patients admitted with COVID-19 is unknown. This presents an opportunity to evaluate important outcomes of ICU care related to this novel pandemic virus. Although we anticipate the effect on our patients with frailty will be devastating, we need to bring frailty to the forefront to determine if it provides a valid incremental improvement in predicting outcomes for this vulnerable group. Our team is in a unique position to access province-wide ICU data inclusive of frailty score to provide a rapid evaluation of COVID-19 patient outcomes of critical illness that could be useful in development or adaptation of triage guidelines and future modifications to care pathways to include frailty.
The objective of this study is to measure the impact of COVID-19 on patient centred outcomes of ICU admission in patients with pre-existing frailty.