King's College London

Research portal

The influence of frailty on survival following COVID-19. The COPE study (COVID in Older People): A multi-centre, European observational cohort study.

Research output: Contribution to journalArticlepeer-review

Jonathan Hewitt, Ben Carter, A Vilches, Terry J. Quinn, Philip Braude, Alessia Verduri, Lyndsay Pearce, Michael J Stechman, Roxanna Short, Angeline Price, Jemima Collins, Eilidh Bruce, Alice Einarsson, Frances Rickard, Emma Mitchell, Mark Holloway, James Hesford, Fenella Barlow-Pay, Enrico Clini, Phyo Myint & 2 more S. J. Moug, Kathryn McCarthy

Original languageEnglish
JournalThe Lancet Public Health
Accepted/In press5 Jun 2020
Published30 Jun 2020


King's Authors


Background: The COVID-19 pandemic has placed unprecedented strain on health care 5 systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the 6 prevalence and effect of frailty in people with COVID-19 is not known. The Cope Study 7 (COVID-19 in Older People) was an observational cohort study designed to address this 8 evidence gap.

Methods: All adults, regardless of age, admitted consecutively with COVID-19 from ten UK 11 and one Italian hospital were included. Frailty was assessed using the Clinical Frailty Scale 12 (CFS). The primary endpoint was in-hospital mortality (time-to-mortality and Day-7 mortality). Data were gathered between 27th February and 28th of April 2020, and analysed with a mixed-effects, Cox proportional hazards and Logistic regression models.

Findings: Data were collected on 1564 people with COVID-19: the median age was 74 years 16 old (IQR, 61-83), 903 were male (57.7%), 425 (27.2%) died in hospital. Using the CFS, 49.6% 17 of people classed as mildly frail or above. The risk of mortality increased with increasing frailty, 18 after adjustment for: age, sex, smoking and comorbidities. The adjusted Hazard Ratio (aHR, 19 95%CI) for CFS 3-4 (managing well, vulnerable), 5-6 (mildly frail and frail) and 7-9 (severely 20 frail, very severely frail and terminally ill) compared to CFS 1-2 (very fit, well) were 1.55 (1.00-21 2.41), 1.83 (1.15-2.91) and 2.39 (1.50-3.81) for time to mortality, and adjusted odds ratio (aOR, 22 95%CI) 1.22 (0.63-2.38), 1.62 (0.81-3.26), 3.12 (1.56-6.24) for Day-7 mortality.

Interpretation: In a large population of people with COVID-19, worsening frailty was associated with increasing mortality. These data provide evidence that frailty is not solely dependent on age and comorbidities. The CFS can inform decision making about medical care in the adult COVID-19 hospital population.

Download statistics

No data available

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454