Clinical frailty scale (CFS) for risk stratification in younger patients hospitalised with covid-19

Background and aim: The importance of frailty is recognised in clinical guidelines for the therapeutic management of diabetes in older people. NICE guidelines recommend that therapeutic decisions should be based on CFS in inpatients with covid-19 aged over 65 years though this has not been validated in people <65 years. We assessed CFS in predicting outcomes in people <65 years with and without diabetes hospitalised with covid-19. Methods: Retrospective analysis of 142 patients, hospitalised with covid-19, aged 35 to 65 years, including 44 patients with diabetes (type 1, n = 5;type 2, n = 39) was undertaken. Results: Thirty-two patients developed severe respiratory failure requiring ventilation, while 9/14 (64.3 %) of those without prior end-stage renal disease required renal replacement therapy (RRT). There were 7 (7.1%) deaths in individuals without and 3 (6.8%) with diabetes. In univariate analysis, CFS was associated with mortality [OR 1.92 (1.27-2.89;p = 0.002)], RRT [OR 1.92 (1.27-2.89;p = 0.002)], length of stay (LOS) [OR 6.2 (3.8-8.58;p < 0.001)] in the whole cohort. In people with diabetes, CFS was associated with increased LOS [OR 6.6 (2.1-11.1;p = 0.005)] and need for RRT [OR 1.66 (0.98-2.81;p = 0.058)]. We observed an interaction with BMI whereby the effect of CFS on LOS was greater at higher BMI [β = 0.35 (0.05-0.64, p = 0.021)]. Conclusion: CFS predicts severe covid-19 in people <65 years with and without diabetes. Patients <65 years of age should be assessed for frailty as they may be candidates for early intervention and enhanced monitoring.