Clinical Interventions in Aging (Nov 2023)
Frailty and Adverse Outcomes After SARS-CoV-2 Infection in Elderly Patients on Maintenance Hemodialysis: A Cohort Study
Abstract
Yifan Yang,1,* Huayu Yang,1,* Zongli Diao,2 Xu Liu,2 Lan Yao,1 Liyan Wang,2 Xiaotian Shi,1 Xu Li,1 Qing Ma1 1Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Qing Ma, Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, 95, Yong-an Road, Xicheng District, Beijing, 100050, People’s Republic of China, Tel +86 10 63137641, Fax +86 10 63138730, Email [email protected]: Frailty is an important geriatric syndrome associated with aging and adverse events, especially in patients with severe infection. To help guide prognosis for elderly patients undergoing maintenance hemodialysis (MHD) who experience acute infection, this study investigated whether baseline (pre-infection) frailty may be associated with adverse outcomes in elderly patients undergoing MHD who suffer SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection.Patients and Methods: Patients (aged ≥ 60 y) receiving MHD had been assessed for overall frailty and the 5 frailty components based on the Fried Frailty Phenotype scale within 3 months prior to SARS-CoV-2 infection.Results: There were 59 and 98 patients in the frail and non-frail groups, respectively. Three months after SARS-CoV-2 infection, 21 (13.4%) and 45 (28.7%) patients had died or were in hospital. The multivariate COX proportional risk model suggested that the all-cause mortality rate in patients judged overall frail or with low activity was significantly higher compared with that of the non-frail (P = 0.049; 0.003). The multivariate logistic regression analysis showed that hospitalization 3 months after SARS-CoV-2 infection was associated with both overall frailty and low activity (OR 2.276, 95% CI: 1.034– 5.010, P = 0.041; OR 2.809, 95% CI: 1.311– 6.020, P = 0.008, respectively).Conclusion: Overall frailty and specifically low activity were significantly associated with all-cause mortality and hospitalization in this elderly MHD population after SARS-CoV-2 infection. Early assessment of frailty and effective interventions are recommended to improve the prognosis of patients receiving MHD who are at higher risk of acute infection.Keywords: SARS-CoV-2, COVID-19, hemodialysis, frailty, elderly, prognosis
