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Frailty Rate Falls Over Time During Postacute COVID Syndrome
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International Workshop on HIV and Aging, October 13-14, 2022
By Mark Mascolini for NATAP and Virology Education
Among people with lingering COVID symptoms after acute COVID-known as postacute COVID syndrome (PACS)-prevalence of clinic-measured frailty waned over time [1]. Researchers from the University of Modena and Reggio Emilia suggested their finding could mean "frailty in COVID-19 survivors might be reversable." In this 823-person study, health-related quality of life (HRQoL) did not improve during PACS.
The Modena researchers noted that frailty emerged as a clinical outcome predictor during acute COVID, but its impact during PACS remains poorly understood. To track changes in frailty phenotype over time during PACS, they conducted this observational study at a single center, the Modena PACS Clinic, from July 2020 to May 2022. The PACS clinic is a referral center that screens COVID survivors for signals of PACS and conducts comprehensive geriatric assessments, including a frailty assessment.
This PACS frailty analysis involved people who had at least 2 follow-up visits at the PACS clinic. The researchers diagnosed PACS if a person had 1 or more clusters of symptoms-respiratory, neurocognitive, musculoskeletal, psychological, sensory, or dermatologic. The investigators assessed HRQoL with the EQ-5D-5L questionnaire [2], defining optimal quality of life as a score above 89.7%.
The study included 823 people assessed for PACS, of whom 60% were male and whose age averaged 60.3 years. At the initial visit, high proportions of the study group were overweight (40.5%) or obese (36.6%). Initial frailty prevalence stood at 30.5%. Frequency of initial PACS clusters in descending order were musculoskeletal (72.5%), neurocognitive (50.7%), respiratory (49.7%), psychological (47.8%), sensory (47.5%), and metabolic (31.4%). Only one third of participants (32.1%) had optimal HRQoL.
Frailty prevalence improved from the initial visit to the follow-up visit (39.5% to 25.5%), while the prefrailty rate edged up (54.3% to 59.7%), as did the fit (nonfrail) rate (6.2% to 14.8%) (P = 0.001 overall). Prevalence of three PACS clusters (musculoskeletal, neurocognitive, sensory) improved over time, while prevalence of the other three PACS clusters (respiratory, psychological, metabolic) and HRQoL did not change significantly. Average body mass index rose slightly but significantly from the first visit to the follow-up visit (29.3 to 29.6 kg/m2, P = 0.01).
Multivariate logistic regression saw a significant association of frailty with the metabolic cluster (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.09 to 8.06), but there was no such association for prefrailty. In an unadjusted model, risk of being frail fell over time (OR 0.98, 95% CI 0.97 to 0.99), as did the risk of being prefrail (OR 0.99, 95% CI 0.98 to 1.00).
The Modena group concluded that frailty prevalence fell over time during PACS, a result indicating that frailty "might be reversable" in COVID-19 survivors.
References
1. Milic J, Renzetti S, Motta F, et al. Frailty transitions in people with post-acute COVID syndrome. International Workshop on HIV and Aging, October 13-14, 2022. Abstract 37.
2. EQ-5D-5L User Guide. https://www.unmc.edu/centric/_documents/EQ-5D-5L.pdf
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