Role of frailty in COVID-19 patients
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CORRESPONDENCE
Role of frailty in COVID‑19 patients Chia Siang Kow1* and Syed Shahzad Hasan2 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, The study by Bellelli et al. [1] has suggested the importance of frailty screening upon admission with COVID19. Nevertheless, the frailty assessment tool (Frailty Index) utilized by Bellelli et al. [1] incorporated the presence/absence of various comorbidities including hypertension, cardiovascular/cerebrovascular diseases, diabetes, and chronic respiratory diseases, amongst others, as part of the assessment of frailty. In fact, the items on comorbidity constituted more than half of the items incorporated by authors for frailty assessment with the Frailty Index (23/43; 53%). However, presence of comorbidities, especially with the aforementioned diseases, has been independently associated with worse clinical outcomes in COVID-19 patients [2]. Therefore, the true association of frailty with clinical outcomes in COVID-19 may not be illustratable with Frailty Index where comorbidity forms the majority of frailty evaluation, which could confound such association. In this context, it is also important to re-visit the differential concepts of frailty and comorbidity. Frailty is regarded as the accumulation of subclinical declines in multiple aspects including physicality, functionality, cognition, and sociality, while comorbidity, which is regarded as the accumulation of clinically manifest diseases present in an individual, represents only one of the etiological factors of frailty [3, 4]. Therefore, frailty and comorbidity are two overlapping but distinct concepts, and both may predict disability, which is defined as a dependency in carrying out activities of daily living [4]. It is worth mentioning that Bellelli et al. also included eight items of disability, where altogether the items on comorbidity and disability constituted nearly three-quarters of
*Correspondence: [email protected] 1 School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia Full author information is available at the end of the article
the total items for frailty assessment with Frailty Index (31/43; 72%). More useful tools for assessment of frailty in COVID19 patients, which measure frailty on multi-domain, and the presence/absence of comorbidity and/or disability do not form the majority part of the frailty evaluation, including Fried’s Frailty Phenotype, Frailty Index derived from Comprehensive Geriatric Assessment, Edmonton Frailty Scale, Fatigue, Resistance, Ambulation, Illness, and Loss of Weight Index (FRAIL), Multidimensional Prognostic Index, Tilburg Frailty Index, Groningen Frailty Indicator, Sherbrooke Postal Questionnaire, and Gérontopôle Frailty Screening Tool [5] In addition, among COVID-19 patients who are severely ill and unconscious, especially those in the intensive care units who are unable to meaningfully participate in frailty assessment, Clinical Frailty Scale may be used [5]. All the aforementioned tools have a signific
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