The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis

Pim Bouwmans; Lloyd Brandts; Luuk B Hilbrands; Raphaël Duivenvoorden; Priya Vart; Casper F M Franssen; Adrian Covic; Mahmud Islam; Clémentine Rabaté; Kitty J Jager; Marlies Noordzij; Ron T Gansevoort; Marc H Hemmelder; ERACODA Collaborators

doi:10.1093/ndt/gfac246

The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis

Pim Bouwmans, Lloyd Brandts, Luuk B Hilbrands, Raphaël Duivenvoorden, Priya Vart, Casper F M Franssen, Adrian Covic, Mahmud Islam, Clémentine Rabaté, Kitty J Jager, Marlies Noordzij, Ron T Gansevoort, Marc H Hemmelder^*, ERACODA Collaborators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill 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.

METHODS: We 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.

RESULTS: 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. ICU admission rate was lowest (5%) in patients >75 years with CFS 7-9 and highest (27%) in patients 65-75 years with CFS 5. CFS 7-9 was associated with a lower ICU admission rate than CFS 1-3 (RR 0.49; 95%CI 0.27-0.87). Overall, mortality at three months was 34% in hospitalized patients, 65% in ICU admitted patients and highest in patients >75 years with CFS 7-9 (69%). Only 9% of patients with 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 CFS 1-3.

CONCLUSIONS: Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

Original language	English
Number of pages	11
Journal	Nephrology Dialysis Transplantation
DOIs	https://doi.org/10.1093/ndt/gfac246
Publication status	E-pub ahead of print - 24 Aug 2022

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10.1093/ndt/gfac246Licence: CC BY-NC

Cite this

Bouwmans, P., Brandts, L., Hilbrands, L. B., Duivenvoorden, R., Vart, P., Franssen, C. F. M., Covic, A., Islam, M., Rabaté, C., Jager, K. J., Noordzij, M., Gansevoort, R. T., Hemmelder, M. H., & ERACODA Collaborators (2022). The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis. Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfac246

@article{36ccacb5de4f430a9911b327ffae3d38,

title = "The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis",

abstract = "BACKGROUND: Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill 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.METHODS: We 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.RESULTS: 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. ICU admission rate was lowest (5%) in patients >75 years with CFS 7-9 and highest (27%) in patients 65-75 years with CFS 5. CFS 7-9 was associated with a lower ICU admission rate than CFS 1-3 (RR 0.49; 95%CI 0.27-0.87). Overall, mortality at three months was 34% in hospitalized patients, 65% in ICU admitted patients and highest in patients >75 years with CFS 7-9 (69%). Only 9% of patients with 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 CFS 1-3.CONCLUSIONS: Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.",

author = "Pim Bouwmans and Lloyd Brandts and Hilbrands, {Luuk B} and Rapha{\"e}l Duivenvoorden and Priya Vart and Franssen, {Casper F M} and Adrian Covic and Mahmud Islam and Cl{\'e}mentine Rabat{\'e} and Jager, {Kitty J} and Marlies Noordzij and Gansevoort, {Ron T} and Hemmelder, {Marc H} and {ERACODA Collaborators}",

note = "{\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.",

year = "2022",

month = aug,

day = "24",

doi = "10.1093/ndt/gfac246",

language = "English",

journal = "Nephrology Dialysis Transplantation",

issn = "0931-0509",

publisher = "Oxford University Press",

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Bouwmans, P , Brandts, L, Hilbrands, LB, Duivenvoorden, R, Vart, P, Franssen, CFM, Covic, A, Islam, M, Rabaté, C, Jager, KJ, Noordzij, M, Gansevoort, RT, Hemmelder, MH & ERACODA Collaborators 2022, 'The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis', Nephrology Dialysis Transplantation. https://doi.org/10.1093/ndt/gfac246

TY - JOUR

T1 - The clinical frailty scale as a triage tool for ICU admission of dialysis patients with COVID-19 - An ERACODA analysis

AU - Bouwmans, Pim

AU - Brandts, Lloyd

AU - Hilbrands, Luuk B

AU - Duivenvoorden, Raphaël

AU - Vart, Priya

AU - Franssen, Casper F M

AU - Covic, Adrian

AU - Islam, Mahmud

AU - Rabaté, Clémentine

AU - Jager, Kitty J

AU - Noordzij, Marlies

AU - Gansevoort, Ron T

AU - Hemmelder, Marc H

AU - ERACODA Collaborators

PY - 2022/8/24

Y1 - 2022/8/24

N2 - BACKGROUND: Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill 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.METHODS: We 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.RESULTS: 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. ICU admission rate was lowest (5%) in patients >75 years with CFS 7-9 and highest (27%) in patients 65-75 years with CFS 5. CFS 7-9 was associated with a lower ICU admission rate than CFS 1-3 (RR 0.49; 95%CI 0.27-0.87). Overall, mortality at three months was 34% in hospitalized patients, 65% in ICU admitted patients and highest in patients >75 years with CFS 7-9 (69%). Only 9% of patients with 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 CFS 1-3.CONCLUSIONS: Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

AB - BACKGROUND: Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill 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.METHODS: We 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.RESULTS: 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. ICU admission rate was lowest (5%) in patients >75 years with CFS 7-9 and highest (27%) in patients 65-75 years with CFS 5. CFS 7-9 was associated with a lower ICU admission rate than CFS 1-3 (RR 0.49; 95%CI 0.27-0.87). Overall, mortality at three months was 34% in hospitalized patients, 65% in ICU admitted patients and highest in patients >75 years with CFS 7-9 (69%). Only 9% of patients with 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 CFS 1-3.CONCLUSIONS: Frail dialysis patients with COVID-19 were less frequently admitted to the ICU. Large differences in mortality rates between fit and frail patients suggest that CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

U2 - 10.1093/ndt/gfac246

DO - 10.1093/ndt/gfac246

M3 - Article

C2 - 36002034

SN - 0931-0509

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

ER -