Study on the correlation between symptoms of coronavirus disease 2019 and frailty_West China Medical Journal

Authors：

CHEN Muxin ¹ , LIANG Hao ² , LI Mingquan ³ , PENG Yinying ⁴ , YANG Youyou ⁵ , ZHOU Shuangjun ⁶ , ZHANG Xiaopei ⁷ ,  WEI Lin ⁸

1. The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, P. R. China;
2. Department of Neurosurgery, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P. R. China;
3. Department of Anesthesiology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P. R. China;
4. Department of Rehabilitation, University City Branch Hospital of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P. R. China;
5. Department of Transplantation, University City Branch Hospital of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P. R. China;
6. Department of Otorhinolaryngology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P. R. China;
7. Department of Neurology, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P. R. China;
8. Department of Nursing, the Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510120, P. R. China;

Corresponding author：

WEI Lin, Email: weilin22@gzucm.edu.cn

Keywords：

Coronavirus disease 2019; coronavirus disease 2019 symptom score; frailty; a cross-sectional study

DOI：

10.7507/1002-0179.202306045

Video：

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Objective To investigate the status of frailty in patients with coronavirus disease 2019 (COVID-19), and to analyze the influence of COVID-19 disease on the prevalence of frailty. Methods This study was conducted using a cross-sectional survey method. COVID-19 patients admitted to a centralized isolation point in Guangzhou were selected for an questionnaire survey by “questionnaire star”, between November and December 2022. The questionnaire included the general information questionnaire, Tilburg Frailty Indicator (TFI), the COVID-19 symptom scale and Mental Resilience Scale (RS-11). Multi-model logistic regression analysis was used to explore the influence of COVID-19 on the occurrence of debilitation. Results A total of 667 questionnaires were distributed, of which 594 were valid, with an effective rate of 89.1%. There were 150 patients (25.3%) were frail, 444 patients (74.7%) were non-frail, and 51 patients (8.6%) were newly frail after infected COVID-19. The median TFI score before COVID-19 was 3 (2, 4) points, 16.7% (99/594) were in a weak state. The median TFI score after COVID-19 was 3 (2, 5) points, 25.3% (150/594) were in a weak state. There were statistically significant differences in TFI scores (Z=−6.596, P＜0.001) and the incidence of debilitation (χ²=351.648, P＜0.001) before and after COVID-19. The results of multivariate logistic regression analysis showed that after controlling disease factors, demographic factors and psychosocial factors, the score of the COVID-19 symptom score was always the influencing factor of COVID-19 patients. The overall change trend of COVID-19 symptom score was statistically significant (P<0.001). Conclusions The COVID-19 symptom score is an important risk factor or predictor of frailty in patients with COVID-19. As the level of COVID-19 symptom score increases, the risk of frailty in COVID-19 patients increases.

Citation： CHEN Muxin, LIANG Hao, LI Mingquan, PENG Yinying, YANG Youyou, ZHOU Shuangjun, ZHANG Xiaopei, WEI Lin. Study on the correlation between symptoms of coronavirus disease 2019 and frailty. West China Medical Journal, 2023, 38(9): 1360-1366. doi: 10.7507/1002-0179.202306045 Copy

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2.	Dent E, Martin FC, Bergman H, et al. Management of frailty: opportunities, challenges, and future directions. Lancet, 2019, 394(10206): 1376-1386.
3.	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
4.	Yamada M, Kimura Y, Ishiyama D, et al. The Influence of the COVID-19 pandemic on physical activity and new incidence of frailty among initially non-frail older adults in Japan: a follow-up online survey. J Nutr Health Aging, 2021, 25(6): 751-756.
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14.	Gobbens RJ, van Assen MA, Luijkx KG, et al. The tilburg frailty indicator: psychometric properties. J Am Med Dir Assoc, 2010, 11(5): 344-355.
15.	司华新, 金雅茹, 乔晓霞, 等. 中文版 Tilburg 衰弱量表在养老机构老年人中的信效度检验. 中国老年学杂志, 2018, 38(16): 4046-4049.
16.	Spinato G, Fabbris C, Conte F, et al. COVID-Q: validation of the first COVID-19 questionnaire based on patient-rated symptom gravity. Int J Clin Pract, 2021, 75(12): e14829.
17.	Chen P, Nirula A, Heller B, et al. SARS-CoV-2 neutralizing antibody LY-CoV555 in outpatients with Covid-19. N Engl J Med, 2021, 384(3): 229-237.
18.	高志华, 杨绍清, Juergen Margraf, 等. Wagnild-Young 心理弹性量表 (RS-11) 中文版的信效度检验. 中国健康心理学杂志, 2013, 21(9): 1324-1326.
19.	Rohrmann S. Epidemiology of frailty in older people. Adv Exp Med Biol, 2020, 1216: 21-27.
20.	Marengoni A, Vetrano DL, Manes-Gravina E, et al. The relationship between COPD and frailty: a systematic review and meta-analysis of observational studies. Chest, 2018, 154(1): 21-40.
21.	Hanlon P, Fauré I, Corcoran N, et al. Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis. Lancet Healthy Longev, 2020, 1(3): e106-e116.
22.	Palmer K, Vetrano DL, Padua L, et al. Frailty syndromes in persons with cerebrovascular disease: a systematic review and meta-analysis. Front Neurol, 2019, 10: 1255.
23.	Alvarez-Nebreda ML, Bentov N, Urman RD, et al. Recommendations for preoperative management of frailty from the society for perioperative assessment and quality improvement (SPAQI). J Clin Anesth, 2018, 47: 33-42.
24.	Renne I, Gobbens RJ. Effects of frailty and chronic diseases on quality of life in Dutch community-dwelling older adults: a cross-sectional study. Clin Interv Aging, 2018, 13: 325-334.
25.	Evans NR, Todd OM, Minhas JS, et al. Frailty and cerebrovascular disease: concepts and clinical implications for stroke medicine. Int J Stroke, 2022, 17(3): 251-259.
26.	Griffith LE, Raina P, Kanters D, et al. Frailty differences across population characteristics associated with health inequality: a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA). BMJ Open, 2021, 11(7): e047945.
27.	St John PD, Montgomery PR, Tyas S. Social position and frailty. Can J Aging, 2013, 32(3): 250-259.
28.	Chamberlain AM, St Sauver JL, Jacobson DJ, et al. Social and behavioural factors associated with frailty trajectories in a population-based cohort of older adults. BMJ Open, 2016, 6(5): e011410.
29.	Welstead M, Jenkins ND, Russ TC, et al. A systematic review of frailty trajectories: their shape and influencing factors. Gerontologist, 2021, 61(8): e463-e475.
30.	谢思琦, 马颖, 崔敏, 等. 老年人心理弹性与生活质量关系的 meta 分析. 中国心理卫生杂志, 2022, 36(1): 56-61.
31.	Kohler S, Rametta R, Poulter M, et al. Resilience, frailty and outcomes in geriatric rehabilitation. Australas J Ageing, 2020, 39(2): e205-e209.
32.	雷鹏琼, 刘春娜, 高颖, 等. 心理社会因素与社区老年人衰弱的相关性研究. 中国全科医学, 2018, 21(2): 180-185.
33.	Padilha de Lima A, Macedo Rogero M, Araujo Viel T, et al. Interplay between inflammaging, frailty and nutrition in Covid-19: preventive and adjuvant treatment perspectives. J Nutr Health Aging, 2022, 26(1): 67-76.
34.	She Q, Chen B, Liu W, et al. Frailty pathogenesis, assessment, and management in older adults with COVID-19. Front Med (Lausanne), 2021, 8: 694367.
35.	Wang Y, van Boxel-Dezaire AH, Cheon H, et al. STAT3 activation in response to IL-6 is prolonged by the binding of IL-6 receptor to EGF receptor. Proc Natl Acad Sci U S A, 2013, 110(42): 16975-16980.
36.	Zhu Y, Sealy MJ, Jager-Wittenaar H, et al. Frailty and risk of hospitalization from COVID-19 infection among older adults: evidence from the dutch lifelines COVID-19 cohort study. Aging Clin Exp Res, 2022, 34(11): 2693-2702.
37.	Ali AM, Kunugi H. Screening for sarcopenia (physical frailty) in the COVID-19 era. Int J Endocrinol, 2021, 2021: 5563960.

1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
2. Dent E, Martin FC, Bergman H, et al. Management of frailty: opportunities, challenges, and future directions. Lancet, 2019, 394(10206): 1376-1386.
3. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci, 2001, 56(3): M146-M156.
4. Yamada M, Kimura Y, Ishiyama D, et al. The Influence of the COVID-19 pandemic on physical activity and new incidence of frailty among initially non-frail older adults in Japan: a follow-up online survey. J Nutr Health Aging, 2021, 25(6): 751-756.
5. Subramaniam A, Shekar K, Afroz A, et al. Frailty and mortality associations in patients with COVID-19: a systematic review and meta-analysis. Intern Med J, 2022, 52(5): 724-739.
6. Zhang XM, Jiao J, Cao J, et al. Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis. BMC Geriatr, 2021, 21(1): 186.
7. Dumitrascu F, Branje KE, Hladkowicz ES, et al. Association of frailty with outcomes in individuals with COVID-19: a living review and meta-analysis. J Am Geriatr Soc, 2021, 69(9): 2419-2429.
8. Lee YK, Motwani Y, Brook J, et al. Predictors of COVID-19 outcomes: interplay of frailty, comorbidity, and age in COVID-19 prognosis. Medicine (Baltimore), 2022, 101(51): e32343.
9. De Smet R, Mellaerts B, Vandewinckele H, et al. Frailty and mortality in hospitalized older adults with COVID-19: retrospective observational study. J Am Med Dir Assoc, 2020, 21(7): 928-932. e1.
10. Davis P, Gibson R, Wright E, et al. Atypical presentations in the hospitalised older adult testing positive for SARS-CoV-2: a retrospective observational study in Glasgow, Scotland. Scott Med J, 2021, 66(2): 89-97.
11. Wijeysundera HC, Abdel-Qadir H, Qiu F, et al. Relationship of frailty with excess mortality during the COVID-19 pandemic: a population-level study in Ontario, Canada. Aging Clin Exp Res, 2022, 34(10): 2557-2565.
12. Salive ME. Multimorbidity in older adults. Epidemiol Rev, 2013, 35: 75-83.
13. Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr, 2017, 17(1): 230.
14. Gobbens RJ, van Assen MA, Luijkx KG, et al. The tilburg frailty indicator: psychometric properties. J Am Med Dir Assoc, 2010, 11(5): 344-355.
15. 司华新, 金雅茹, 乔晓霞, 等. 中文版 Tilburg 衰弱量表在养老机构老年人中的信效度检验. 中国老年学杂志, 2018, 38(16): 4046-4049.
16. Spinato G, Fabbris C, Conte F, et al. COVID-Q: validation of the first COVID-19 questionnaire based on patient-rated symptom gravity. Int J Clin Pract, 2021, 75(12): e14829.
17. Chen P, Nirula A, Heller B, et al. SARS-CoV-2 neutralizing antibody LY-CoV555 in outpatients with Covid-19. N Engl J Med, 2021, 384(3): 229-237.
18. 高志华, 杨绍清, Juergen Margraf, 等. Wagnild-Young 心理弹性量表 (RS-11) 中文版的信效度检验. 中国健康心理学杂志, 2013, 21(9): 1324-1326.
19. Rohrmann S. Epidemiology of frailty in older people. Adv Exp Med Biol, 2020, 1216: 21-27.
20. Marengoni A, Vetrano DL, Manes-Gravina E, et al. The relationship between COPD and frailty: a systematic review and meta-analysis of observational studies. Chest, 2018, 154(1): 21-40.
21. Hanlon P, Fauré I, Corcoran N, et al. Frailty measurement, prevalence, incidence, and clinical implications in people with diabetes: a systematic review and study-level meta-analysis. Lancet Healthy Longev, 2020, 1(3): e106-e116.
22. Palmer K, Vetrano DL, Padua L, et al. Frailty syndromes in persons with cerebrovascular disease: a systematic review and meta-analysis. Front Neurol, 2019, 10: 1255.
23. Alvarez-Nebreda ML, Bentov N, Urman RD, et al. Recommendations for preoperative management of frailty from the society for perioperative assessment and quality improvement (SPAQI). J Clin Anesth, 2018, 47: 33-42.
24. Renne I, Gobbens RJ. Effects of frailty and chronic diseases on quality of life in Dutch community-dwelling older adults: a cross-sectional study. Clin Interv Aging, 2018, 13: 325-334.
25. Evans NR, Todd OM, Minhas JS, et al. Frailty and cerebrovascular disease: concepts and clinical implications for stroke medicine. Int J Stroke, 2022, 17(3): 251-259.
26. Griffith LE, Raina P, Kanters D, et al. Frailty differences across population characteristics associated with health inequality: a cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging (CLSA). BMJ Open, 2021, 11(7): e047945.
27. St John PD, Montgomery PR, Tyas S. Social position and frailty. Can J Aging, 2013, 32(3): 250-259.
28. Chamberlain AM, St Sauver JL, Jacobson DJ, et al. Social and behavioural factors associated with frailty trajectories in a population-based cohort of older adults. BMJ Open, 2016, 6(5): e011410.
29. Welstead M, Jenkins ND, Russ TC, et al. A systematic review of frailty trajectories: their shape and influencing factors. Gerontologist, 2021, 61(8): e463-e475.
30. 谢思琦, 马颖, 崔敏, 等. 老年人心理弹性与生活质量关系的 meta 分析. 中国心理卫生杂志, 2022, 36(1): 56-61.
31. Kohler S, Rametta R, Poulter M, et al. Resilience, frailty and outcomes in geriatric rehabilitation. Australas J Ageing, 2020, 39(2): e205-e209.
32. 雷鹏琼, 刘春娜, 高颖, 等. 心理社会因素与社区老年人衰弱的相关性研究. 中国全科医学, 2018, 21(2): 180-185.
33. Padilha de Lima A, Macedo Rogero M, Araujo Viel T, et al. Interplay between inflammaging, frailty and nutrition in Covid-19: preventive and adjuvant treatment perspectives. J Nutr Health Aging, 2022, 26(1): 67-76.
34. She Q, Chen B, Liu W, et al. Frailty pathogenesis, assessment, and management in older adults with COVID-19. Front Med (Lausanne), 2021, 8: 694367.
35. Wang Y, van Boxel-Dezaire AH, Cheon H, et al. STAT3 activation in response to IL-6 is prolonged by the binding of IL-6 receptor to EGF receptor. Proc Natl Acad Sci U S A, 2013, 110(42): 16975-16980.
36. Zhu Y, Sealy MJ, Jager-Wittenaar H, et al. Frailty and risk of hospitalization from COVID-19 infection among older adults: evidence from the dutch lifelines COVID-19 cohort study. Aging Clin Exp Res, 2022, 34(11): 2693-2702.
37. Ali AM, Kunugi H. Screening for sarcopenia (physical frailty) in the COVID-19 era. Int J Endocrinol, 2021, 2021: 5563960.

West China Medical Journal

Study on the correlation between symptoms of coronavirus disease 2019 and frailty

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