The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis

Pim Bouwmans; Lloyd Brandts; ERACODA Collaborators; 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

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
, ERACODA Collaborators
, 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

Internal Medicine

Maastricht University
Radboud University Medical Center
University Medical Centre Groningen
Grigore T. Popa University of Medicine and Pharmacy
Zonguldak Ataturk State Hospital
Claude Galien Hospital Ramsay Santé
Amsterdam UMC, Locatie VUmc

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

10 Citations (Scopus)

172 Downloads (Pure)

Abstract

Background Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (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 A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7-9 and highest (27%) in patients 65-75 years of age with a CFS of 5. A CFS of 7-9 was associated with a lower ICU admission rate than a CFS of 1-3 [relative risk 0.49 (95% confidence interval 0.27-0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7-9 (69%). Only 9% of patients with a 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 a CFS of 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 the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

Original language	English
Pages (from-to)	2264-2274
Number of pages	11
Journal	Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Volume	37
Issue number	11
Early online date	24 Aug 2022
DOIs	https://doi.org/10.1093/ndt/gfac246
Publication status	Published - 1 Nov 2022

Bibliographical note

Funding Information:
We thank all the people that entered information in the ERACODA database for their participation and especially all healthcare workers who have taken care of the included COVID-19 patients. The ERACODA collaboration is an initiative endorsed by the ERA to study the prognosis and risk factors for mortality due to COVID-19 in patients with a kidney transplant or on dialysis. The organizational structure contains a Working Group [C. F. M. Franssen, R. T. Gansevoort (coordinator), M. H. Hemmelder, L. B. Hilbrands and K. J. Jager] assisted by a Management Team (R. Duivenvoorden, M. Noordzij, P. Vart) and an Advisory Board (D. Abramowicz, C. Basile, A. Covic, M. Crespo, Z. A. Massy, S. Mitra, E. Petridou, J. E. Sanchez and C. White). The ERACODA received unrestricted research grants from the ERA, the Dutch Kidney Foundation, Baxter and Sandoz. None of these organizations had any role in the design of the study, interpretation of results or in writing of the manuscript.

Publisher Copyright:
© The Author(s) 2022.

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Cite this

Bouwmans, P., Brandts, L., ERACODA Collaborators, 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. (2022). The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 37(11), 2264-2274. https://doi.org/10.1093/ndt/gfac246

@article{d6406ad7f5e94ecaa1082a29dbbfb201,

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 coronavirus disease 2019 (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 A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15\%) were admitted to an ICU. The ICU admission rate was lowest (5\%) in patients >75 years of age with a CFS of 7-9 and highest (27\%) in patients 65-75 years of age with a CFS of 5. A CFS of 7-9 was associated with a lower ICU admission rate than a CFS of 1-3 [relative risk 0.49 (95\% confidence interval 0.27-0.87)]. Overall, mortality at 3 months was 34\% in hospitalized patients, 65\% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7-9 (69\%). Only 9\% of patients with a 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 a CFS of 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 the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.",

author = "Pim Bouwmans and Lloyd Brandts and \{ERACODA Collaborators\} 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 Marlies Reinders and \{van de Wetering\}, Jacqueline and Dennis Hesselink and \{van Gestel\}, Judith",

note = "Funding Information: We thank all the people that entered information in the ERACODA database for their participation and especially all healthcare workers who have taken care of the included COVID-19 patients. The ERACODA collaboration is an initiative endorsed by the ERA to study the prognosis and risk factors for mortality due to COVID-19 in patients with a kidney transplant or on dialysis. The organizational structure contains a Working Group [C. F. M. Franssen, R. T. Gansevoort (coordinator), M. H. Hemmelder, L. B. Hilbrands and K. J. Jager] assisted by a Management Team (R. Duivenvoorden, M. Noordzij, P. Vart) and an Advisory Board (D. Abramowicz, C. Basile, A. Covic, M. Crespo, Z. A. Massy, S. Mitra, E. Petridou, J. E. Sanchez and C. White). The ERACODA received unrestricted research grants from the ERA, the Dutch Kidney Foundation, Baxter and Sandoz. None of these organizations had any role in the design of the study, interpretation of results or in writing of the manuscript. Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2022",

month = nov,

day = "1",

doi = "10.1093/ndt/gfac246",

language = "English",

volume = "37",

pages = "2264--2274",

journal = "Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association",

issn = "0931-0509",

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number = "11",

}

Bouwmans, P, Brandts, L, ERACODA Collaborators, Hilbrands, LB, Duivenvoorden, R, Vart, P, Franssen, CFM, Covic, A, Islam, M, Rabaté, C, Jager, KJ, Noordzij, M, Gansevoort, RT & Hemmelder, MH 2022, 'The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis', Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, vol. 37, no. 11, pp. 2264-2274. https://doi.org/10.1093/ndt/gfac246

The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis. / Bouwmans, Pim; Brandts, Lloyd; ERACODA Collaborators et al.
In: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, Vol. 37, No. 11, 01.11.2022, p. 2264-2274.

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

TY - JOUR

T1 - The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19

T2 - an ERACODA analysis

AU - Bouwmans, Pim

AU - Brandts, Lloyd

AU - ERACODA Collaborators

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 - Reinders, Marlies

AU - van de Wetering, Jacqueline

AU - Hesselink, Dennis

AU - van Gestel, Judith

N1 - Funding Information: We thank all the people that entered information in the ERACODA database for their participation and especially all healthcare workers who have taken care of the included COVID-19 patients. The ERACODA collaboration is an initiative endorsed by the ERA to study the prognosis and risk factors for mortality due to COVID-19 in patients with a kidney transplant or on dialysis. The organizational structure contains a Working Group [C. F. M. Franssen, R. T. Gansevoort (coordinator), M. H. Hemmelder, L. B. Hilbrands and K. J. Jager] assisted by a Management Team (R. Duivenvoorden, M. Noordzij, P. Vart) and an Advisory Board (D. Abramowicz, C. Basile, A. Covic, M. Crespo, Z. A. Massy, S. Mitra, E. Petridou, J. E. Sanchez and C. White). The ERACODA received unrestricted research grants from the ERA, the Dutch Kidney Foundation, Baxter and Sandoz. None of these organizations had any role in the design of the study, interpretation of results or in writing of the manuscript. Publisher Copyright: © The Author(s) 2022.

PY - 2022/11/1

Y1 - 2022/11/1

N2 - Background Several guidelines recommend using the Clinical Frailty Scale (CFS) for triage of critically ill coronavirus disease 2019 (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 A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7-9 and highest (27%) in patients 65-75 years of age with a CFS of 5. A CFS of 7-9 was associated with a lower ICU admission rate than a CFS of 1-3 [relative risk 0.49 (95% confidence interval 0.27-0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7-9 (69%). Only 9% of patients with a 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 a CFS of 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 the 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 coronavirus disease 2019 (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 A total of 1501 dialysis patients were hospitalized due to COVID-19, of whom 219 (15%) were admitted to an ICU. The ICU admission rate was lowest (5%) in patients >75 years of age with a CFS of 7-9 and highest (27%) in patients 65-75 years of age with a CFS of 5. A CFS of 7-9 was associated with a lower ICU admission rate than a CFS of 1-3 [relative risk 0.49 (95% confidence interval 0.27-0.87)]. Overall, mortality at 3 months was 34% in hospitalized patients, 65% in ICU-admitted patients and highest in patients >75 years of age with a CFS of 7-9 (69%). Only 9% of patients with a 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 a CFS of 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 the CFS may be a useful complementary triage tool for ICU admission in dialysis patients with COVID-19.

UR - https://www.scopus.com/pages/publications/85149279015

U2 - 10.1093/ndt/gfac246

DO - 10.1093/ndt/gfac246

M3 - Article

C2 - 36002034

SN - 0931-0509

VL - 37

SP - 2264

EP - 2274

JO - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association

IS - 11

ER -

Bouwmans P, Brandts L, ERACODA Collaborators, Hilbrands LB, Duivenvoorden R, Vart P et al. The Clinical Frailty Scale as a triage tool for ICU admission of dialysis patients with COVID-19: an ERACODA analysis. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2022 Nov 1;37(11):2264-2274. Epub 2022 Aug 24. 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

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