Using an electronic frailty index to predict adverse outcomes in geriatric COVID-19 patients: data from the Stockholm GeroCovid study

BackgroundThe Clinical Frailty Scale (CFS) is a strong predictor for worse outcomes in geriatric COVID-19 patients, but it is less clear whether an electronic frailty index (eFI) constructed from routinely collected electronic health records (EHRs) provides similar predictive value. This study aimed to investigate the predictive ability of an eFI in comparison to other frailty and comorbidity measures, using mortality, readmission, and the length of stay as outcomes in geriatric COVID-19 patients. MethodsWe conducted a retrospective cohort study using EHRs from nine geriatric clinics in Stockholm, Sweden, comprising 3,405 COVID-19 patients (mean age 81.9 years) between 1/3/2020 and 31/10/2021. Frailty was assessed using a 48-item eFI developed for Swedish geriatric patients, the CFS, and Hospital Frailty Risk Score (HFRS). Comorbidity was measured using the Charlson Comorbidity Index (CCI). We analyzed in-hospital mortality and 30-day readmission using logistic regression and area under receiver operating characteristic curve (AUC). 30-day and 6-month mortality were modelled by Cox regression, and the length of stay by linear regression. ResultsControlling for age and sex, a 10% increase in the eFI was associated with higher risks of in-hospital mortality (odds ratio [OR]=2.84; 95% confidence interval=2.31-3.51), 30-day mortality (hazard ratio [HR]=2.30; 1.99-2.65), 6-month mortality (HR=2.33; 2.07-2.62), 30-day readmission (OR=1.34; 1.06-1.68), and longer length of stay ({beta}=2.28; 1.90-2.66). The CFS, HFRS and CCI similarly predicted these outcomes, but the eFI had the best predictive accuracy for in-hospital mortality (AUC=0.775). ConclusionsAn eFI based on routinely collected EHRs can be applied in identifying high-risk geriatric COVID-19 patients.

Frailty and comorbidity in predicting community COVID-19 mortality in the UK Biobank: the effect of sampling

Frailty has been linked to increased risk of COVID-19 mortality, but evidence is mainly limited to hospitalized older individuals and analyses in community samples are scarce. This study aims to assess and compare the predictive abilities of different frailty measures - the frailty phenotype (FP), frailty index (FI), and Hospital Frailty Risk Score (HFRS), and comorbidity, measured using the Charlson Comorbidity Index (CCI), on COVID-19 mortality in a UK community sample of adults aged 52-86 years. We analyzed (i) the full sample of 428,754 UK Biobank participants and (ii) a subsample of 2,287 COVID-19 positive UK Biobank participants with data on COVID-19 outcomes between March 1 and September 21, 2020. COVID-19 positivity was confirmed by PCR, hospital records and/or death registers. Logistic regression models adjusted for age, sex, smoking, ethnicity, and socioeconomic variables with areas under the receiver operating characteristic curves (AUCs) were used in the modelling. Overall, 391 individuals died of COVID-19. In the full sample, all frailty measures and the CCI were associated with COVID-19 mortality but only the HFRS and CCI improved the predictive ability of a model including age and sex, yielding AUCs>0.80. However, when restricting analyses to the COVID-19 positive subsample, which had an over-representation of frail individuals, similar improvement in AUCs was not observed in which only the CCI was significantly associated with COVID-19 mortality. Our results suggest that HFRS and CCI can be used in COVID-19 mortality risk stratification at the population level, but they show limited added value in COVID-19 positive individuals.

Analysis on the heritability of diabetes, based on data from the Chinese adult twins / 中华流行病学杂志

Objective@#To analyze the heritability of diabetes among the Chinese twin adults.@*Methods@#A total of 10 253 same-sex twin pairs aged 25 years and older, were selected from the Chinese National Twin Registry (CNTR) program. Heritability of diabetes was calculated by using the structural equation model.@*Results@#After adjusted for age and gender, the overall heritability rates of diabetes were 0.41 (0.15-0.75), 0.83 (0.72-0.91) and 0.34 (0.04-0.73) in the <45 and ≥45 years twin pairs, respectively. After adjusted for age, rates of heritability appeared as 0.37 (0.05-0.78) and 0.88 (0.79-0.94) in men and women, respectively.@*Conclusions@#Diabetes is affected by both genetic and environmental factors. The genetic effect of diabetes seemed stronger on female than that on male twins but was dying down along with ageing.