Association between a Frailty Index of Laboratory Values (FI-LAB) and Inpatient Mortality in Veterans Hospitalized with COVID-19

Background: Frailty is a syndrome characterized by vulnerability to stressors resulting from multisystemic loss of physiological reserve associated with poor clinical outcomes Recent studies have shown worse outcomes and higher mortality rate in older adults with COVID 19 infection The risk for mortality may be even higher in hospitalized older adults with coexistent frailty and COVID 19 infection The FI-LAB is a validated, objective measure of frailty in acute care settings which is based on laboratory values and vital signs The study aim was to assess the FI-LAB score as a predictor of inpatient mortality in Veterans admitted with COVID-19 Infection Methods: Retrospective cohort study conducted in a population of veterans admitted with COVID-19 infection to 7 VISN 8 acute care facilities across Florida We calculated the 31-item FI-LAB using laboratory values and vital signs upon admission Veterans were categorized as low (0 40) based on FI-LAB scores Differences in inpatient mortality among the 3 FI-LAB groups were determined using a Cox regression model, adjusted for age, BMI, gender, race, and ethnicity Results: 700 patients were hospitalized, mean age 66 03 (range:22-103, SD=14 86) years, Caucasian 58 14% (n=407), non-Hispanic 81 71% (n=572), and 93 86% (n=657) male According to the FI-LAB, 47 42% (n=332), 43 85% (n=307), and 8 71% (n=61) were in the low, moderate and high groups, respectively There were 53 total inpatient deaths (<65, n=6, 11 32% and ≥65 years, n=47, 88 68%): FI-LAB low 10 (3 01%), moderate 3 (10 09%), high 12 (19 67%), p< 0005 The median follow up was 5 days (IQR=12) As compared with the low FI-LAB group, Veterans in the moderate and high groups had higher mortality risk, adjusted hazard ratio (HR)=2 87 (95%CI:1 36-6 06), p=0 006 and HR=5 23 (95%CI:2 10-13 06), respectively, p< 005 Conclusions: Moderate and higher FI-LAB groups were associated with higher inpatient mortality than the low category Most deaths were among older adults The FI-LAB may identify patients at higher mortality risk and assist clinicians in the development of early strategies to reduce mortality in hospitalized older patients with frailty and COVID 19 infection