The following is a summary of “Limited incremental predictive value of the frailty index and other vulnerability measures from routine care data for mortality risk prediction in older patients with COVID-19 in primary care,” published in the February 2024 issue of Primary Care by Roi-Teeuw, et al.

Amid the COVID-19 pandemic, older patients in primary care were assessed for frailty or presumed vulnerability, yet evidence regarding the prognostic value of vulnerability measures in COVID-19 patients in primary care was scarce. Understanding vulnerability’s role is crucial for comprehending older individuals’ resilience during acute illness and is vital for future pandemic readiness. For a study, researchers evaluated the predictive efficacy of various routine care-based vulnerability measures, alongside age and sex, for 28-day mortality in an older primary care population with COVID-19.

Using three Dutch primary care databases, we included all patients aged 70 years or older diagnosed with COVID-19 in 2020 and 2021. Logistic regression was utilized to predict all-cause mortality based solely on age and sex (basic model) and separately by integrating six vulnerability measures: renal function, cognitive impairment, number of chronic drugs, Charlson Comorbidity Index, Chronic Comorbidity Score, and a Frailty Index. We compared the predictive performance of the basic model and the six vulnerability models regarding the area under the receiver operator characteristic curve (AUC), the index of prediction accuracy, and the distribution of predicted risks.

Among the 4,065 patients analyzed, 9% (n = 366) died within 28 days after COVID-19 diagnosis. The predicted mortality risk varied between 7–26% for the basic model (age and sex), increasing to 4–41% with the inclusion of comorbidity-based vulnerability measures (Charlson Comorbidity Index, Chronic Comorbidity Score), which reflected impaired organ functioning. Although the AUC of the basic model slightly increased from 0.69 (95%CI 0.66 – 0.72) to 0.74 (95%CI 0.71 – 0.76) with the addition of these comorbidity scores, the inclusion of a Frailty Index, renal function, chronic drugs count, or cognitive impairment did not substantially alter predictions.

In summary, among older COVID-19 patients in primary care, 28-day mortality was significant at 9%. However, six different vulnerability measures provided minimal additional predictive value beyond age and sex in forecasting short-term mortality.

Reference: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02308-5