key: cord-0078180-maym6anb
authors: Covino, Marcello; Russo, Andrea; Salini, Sara; De Matteis, Giuseppe; Simeoni, Benedetta; Della Polla, Davide; Sandroni, Claudio; Landi, Francesco; Gasbarrini, Antonio; Franceschi, Francesco
title: Reply to “In-hospital mortality risk of older patients with COVID-19 infection”
date: 2022-05-16
journal: J Am Med Dir Assoc
DOI: 10.1016/j.jamda.2022.05.005
sha: 6449dd337d2860f1dc31ad8914cc7f2a44c014d9
doc_id: 78180
cord_uid: maym6anb

nan

To the Editor, 1 We are delighted by the interest in our research by Dr. Kawada and we welcome the opportunity to 2 better clarify the results of our recent study on COVID-19 patients ≥80 years old 1 . In the study, we 3 explored the overlapping effect between clinical covariates and baseline frailty status, in older 4 patients hospitalized for COVID-19. Our results underlined the independent effect of severe frailty on 5 the risk for in-hospital death, as well as male sex, the severity of disease at presentation, and overall 6 comorbidities ≥ 3. gives an about 10 fold risk of death for a patient with CFS=8¸which is pretty similar to the 12-fold 18 estimated risk reported in the paper for the group CFS =7-9. Indeed, apart from the overall estimated 19 HR, the crude figures of mortality clearly indicate that frail patients have an increased risk of death, 20 which is the major finding conveyed by our research.

Since life expectancy is lower in males, it could be speculated that in the older cohorts, such as the 22 one evaluated in our study, the risk of death for males could be increased. However, given the short 23 length of our follow-up (the endpoint was in-hospital mortality), we do not think that this could justify Finally, as noted by Dr. Kawada, we did not consider the BMI among the evaluated variables. The 27 overlapping relationship among low BMI, malnutrition, and sarcopenia is a key determinant of the 28 frailty status. Although a low BMI may be a component of sarcopenia, the two conditions are not the 29 same, neither is malnutrition 3 . Moreover, particularly in older adults, limiting the analysis to BMI 30 could not reflect the nutritional and sarcopenic condition of the patients. 31 We look forward to improving our analysis, including these suggestions, to better clarify the reasons 32 underlying the excess mortality observed in older COVID-19 patients. 

Frailty Assessment in the Emergency Department for Risk 37

Does gender influence clinical expression and disease 39 outcomes in COVID-19? A systematic review and meta-analysis

Sarcopenia: an undiagnosed condition in older adults

Current consensus definition: prevalence, etiology, and consequences. International working 42 group on sarcopenia