Clinical Frailty Scale is useful in predicting return-to-home in patients admitted due to coronavirus disease

Clinical Frailty Scale is useful in predicting return-to-home in patients admitted due to coronavirus disease | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Frailty Scale is useful in predicting return-to-home in patients admitted due to coronavirus disease Koki Kawamura, Aiko Osawa, Masanori Tanimoto, Hitoshi Kagaya, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2722719/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 12 Jul, 2023 Read the published version in BMC Geriatrics → Version 1 posted 10 You are reading this latest preprint version Abstract Background: The spread of the novel SARS-CoV-2 infection prolonged, and the highly contagious Omicron variant became the predominant variant by 2022. Many patients admitted to dedicated coronavirus disease 2019 (COVID-19) wards (COVID-19 Treatment Units) develop disuse syndrome while being treated in hospital, and their ability to perform activities of daily living decline, making it difficult for hospitals to discharge such patients. This study aimed to investigate the relationship between the degree of frailty and home discharge of patients admitted to a COVID-19 Treatment Unit. Methods: The study retrospectively examined the in-patient medical records of 138 patients (82.7±7.6 years) admitted to a COVID-19 Treatment Unit from January to December 2022. The endpoint was whether the patients were able to be discharged from the COVID-19 Treatment Unit directly to home, and were classified into the Home discharge group, compared with the Difficulty in discharge group. The degree of frailty was determined based on Clinical Frailty Scale (CFS), and the relationship with the endpoint was analysed. A Receiver Operating Characteristic (ROC) curve was created and the cut-off value was calculated with the possibility of home discharge set as the state variable and CFS set as the test variable. Logistic regression analysis was conducted with the possibility of home discharge set as the dependent variable and CFS as the independent variable. Results: There were 75 patients in the Home discharge group, and 63 patients in the Difficulty in discharge group. As a result of ROC analysis, the CFS cut-off value was 6 or more, with a sensitivity of 70.7% and specificity of 84.1%. The results of logistic regression analysis showed a significant correlation between possibility of home discharge and CFS even after adjusting for covariates, with an odds ratio of 13.44. Conclusions: It was possible to predict with good accuracy whether a patient could be discharged directly to home after treatment based on the evaluation of the degree of frailty in the COVID-19 Treatment Unit. CFS is effective as a screening tool that can easily detect patients who require ongoing hospitalisation even after the acute phase of treatment in the COVID-19 Treatment Unit. COVID-19 Frailty Predicts discharge Epidemic. Figures Figure 1 Figure 2 Background The spread of the novel coronavirus disease 2019 (COVID-19) has been explosive. As of 2023, it still has not been contained, and its effects are prolonged in various countries throughout the world [ 1 ]. In Japan, the highly contagious Omicron variant became widespread from January 2022, and there have been repeated waves of infection, called the 6th, 7th, and 8th waves, where the number of infected people rapidly increased followed by a fall in the number of infected [ 2 ]. Although this variant is more contagious than that at the beginning of the pandemic, the ratio of deaths to infected persons is falling [ 3 ]. However, the risk of the infection turning severe remains high among the older and people with comorbidities [ 4 , 5 ]. High risk patients and those with highly contagious symptoms are admitted to medical institutions to prevent the spread of infection and the infection becoming more severe. The National Center for Geriatrics and Gerontology (our centre) opened a dedicated ward for patients with COVID-19 (COVID-19 Treatment Unit), and the ward mainly admitted and treated older patients with comorbidities considered to have mild to moderate symptoms. In the COVID-19 Treatment Unit in this centre, preparations for discharge were generally conducted from 10 days after onset. However, many patients could not be immediately discharged to home despite completion of the acute phase of the COVID-19 treatment, due to a decline in Activities of Daily Living (ADL) caused by disuse during treatment. The influencing factors for this phenomenon are thought to be the advanced age of the patients and the existence of comorbidities [ 6 , 7 ], but there are insufficient findings on which kind of patients tend to be difficult to discharge. As a result of preliminary analysis of data of patients admitted to the COVID-19 Treatment Unit in this centre from January to March 2022, we realised that there may be a correlation between frailty and home discharge [ 8 ]. However, there are few reports on COVID-19 and frailty. In this study, we established a hypothesis based on past findings, namely, evaluating the degree of frailty in patients positive for COVID-19 might help to predict whether a patient could be discharged from the COVID-19 Treatment Unit directly to home after completion of the acute phase of treatment. If it is possible to predict cases that are highly likely to be difficult to discharge home from as soon as the early stage of COVID-19 treatment, then providing early and focused rehabilitation to these patients to improve their ADL may be beneficial for preventing disuse during hospitalisation, thereby promoting prompt discharge and return to normal life after treatment [ 9 , 10 ]. Therefore, this study aimed to investigate the relationship between the degree of frailty and home discharge of patients admitted to the COVID-19 Treatment Unit. Methods Participation Of the 231 patients admitted to the COVID-19 Treatment Unit in this centre with positive COVID-19 PCR test results during the 12-month period from January to December 2022, 138 patients (men, n = 85; women, n = 53) were included in the analysis (excluding 16 patients younger than 65 years, 35 patients with hospital-acquired infections, 37 patients who were originally residents of nursing homes, and five patients with severe infections). The in-hospital medical record shown below was retrospectively examined for patients included in the analysis. Assessment The endpoint was whether the patient could be discharged from the COVID-19 Treatment Unit directly to home, and the patients were classified into two groups: patients who were able to be discharged directly to home after completion of the acute phase of the COVID-19 treatment (Home discharge group) and patients who continued to stay in the hospital and required rehabilitation to be discharged home (Difficulty in discharge group). The degree of frailty, as the main item for evaluating the correlation with the endpoint, was determined using the Clinical Frailty Scale (CFS), Japanese version (translated by The Japan Geriatrics Society, 2021). CFS is a comprehensive index for evaluating the degree of frailty on a 9-point scale, proposed by Rockwood et al. [ 11 ]. The scale allocates a high score for decline in both physical and cognitive functions, because the determination considers the level of independence in activities of daily living and the need for nursing care. The evaluation does not require equipment or a long period of time, and CFS is a simple index able to make a comprehensive judgement based on clinical findings [ 12 ], which gives it the advantage of being easy to use under conditions that require special infection controls such as COVID-19 Treatment Units. Age, sex, body mass index (BMI), serum albumin level, severity of COVID-19, comorbidities, Activities of Daily Living ADL (Functional Independent Measure, FIM), sarcopenia (calf circumference, grip strength), physical function (Short Physical Performance Battery, SPPB), and cognitive function (Mini Mental State Examination-Japanese, MMSE-J) were examined as secondary endpoints. The severity of COVID-19 was classified based on the Ministry of Health, Labour and Welfare criteria [ 13 ] as the following: mild, SpO 2 ≥ 96% and no respiratory symptoms; moderate I, 93%<SpO 2 < 96% and dyspnoea or pneumonia findings; and moderate II, requires oxygen therapy with SpO 2 < 93%. Patients with a calf circumference of < 43 cm for men/<33 cm for women, and a grip strength of < 28 kg for men/<18 kg for women were determined to have “possible sarcopenia” in accordance with the AWGS 2019 criteria for sarcopenia [ 14 ]. SPPB is a simple but comprehensive physical function assessment battery that allocates a score of 0 to 12 by testing three items: 4 m walk, the chair stand test completed 5 times, and the standing balance test; the higher the score, the better the motor function [ 1 ]. MMSE-J is the Japanese version of a cognitive function test battery, based on MMSE [ 16 ], which can be conducted relatively easily and allocates a score from 0 to 30; the higher the score, the better the cognitive function [ 17 ]. These evaluations were conducted approximately 5 days after onset, once it was confirmed that the fever had abated, on the day when the in-ward rehabilitation started with the permission and determination of the attending physician. All medical staff involved in the dedicated COVID-19 Treatment Unit complied with infection control measures in accordance with the instructions of the Infection Control Committee. Statistical analysis The Student t-test, Mann-Whitney U-test, χ 2 -test, and Fisher’s exact test were used for comparison of the mean ± standard deviation and median [interquartile range] or percentage (%) descriptions for each endpoint, and for comparison of the possibility of home discharge and each endpoint. An Receiver Operating Characteristic (ROC) curve was created with the possibility of home discharge set as the state variable and CFS set as the test variable, and the cut-off value was calculated at the maximum value of sensitivity, specificity, area under the curve (AUC), and the Youden index. Furthermore, logistic regression analysis was conducted with the possibility of home discharge (Difficult Group = 1) set as the dependent variable and CFS (binary variable at or above/below the Cut-off) as the independent variable. Spearman's rank correlation coefficient was used to diagnose multicollinearity between covariates. SPSS Ver. 28.0 was used for statistical analysis and the level of significance was set at 1%. Results There were no cases of infection among the medical staff in the dedicated COVID-19 Treatment Unit during the survey period, indicating that it is possible to safely provide medical care, nursing, and rehabilitation during the isolation period by adopting appropriate measures. The mean number of days spent in the ward by the 138 patients in the study was 11.2 ± 2.9 days, and the severity of COVID-19 at admission was mild for 58 patients, moderate I for 47, and moderate II for 32. There were 75 patients in the Home discharge group, and 63 patients in the Difficulty in discharge group. The number of people able to be discharged home using the CFS score is shown in Fig. 1 . The median (interquartile range) CFS score was 5 (3–6) in the Home discharge group and 7 (6–7) in the Difficulty in discharge group, and the number of cases that were difficult to discharge increased with the CFS score (P < 0.001, effect size=-0.55). Table 1 shows the results of comparison of each secondary endpoint based on the possibility of home discharge. In the intergroup comparison based on the possibility of home discharge, advanced age, female sex, low BMI, low serum albumin levels, dementia, low total FIM score, reduced calf circumference, low grip strength, possible sarcopenia, low SPPB, and low MMSE-J made discharging to home significantly more difficult. The severity of COVID-19 and the presence/absence of other comorbidities were not associated with the possibility of home discharge. Table 1 Comparison of the clinical characteristics between the "Home discharge" group and the "Difficulty with discharge" group. n = 138 Overall (n = 138) Home discharge group (n = 75) Difficulty with discharge group (n = 63) P value Effect size Age 82.7 ± 7.6 80.9 ± 6.8 85.0 ± 8.0 < 0.001 0.27 Sex_Female 53 (38%) 21 (28%) 32 (51%) < 0.001 0.04 BMI (kg/m 2 ) 21.4 ± 3.8 22.4 ± 3.7 20.2 ± 3.7 < 0.001 0.18 Albumin (g/dl) 3.1 ± 0.6 3.4 ± 0.5 2.9 ± 0.6 < 0.001 0.44 Severity of COVID-19 - Mild - Moderate Ⅰ - Moderate Ⅱ 58 (42%) 47 (34%) 33 (24%) 33 (44%) 29 (39%) 13 (17%) 25 (40%) 18 (28%) 20 (32%) 0.208 0.11 Comorbidities (include duplicates) Cerebrovascular disease 30 (22%) 14 (19%) 16 (25%) 0.340 0.02 Respiratory disease 46 (33%) 26 (35%) 20 (32%) 0.717 0.01 Neuromuscular disease 18 (13%) 11 (15%) 7 (11%) 0.537 0.03 Dementia 81 (59%) 28 (37%) 53 (84%) < 0.001 0.16 Hypertension 52 (38%) 25 (33%) 27 (43%) 0.250 0.02 Diabetes mellitus 27 (20%) 16 (21%) 11 (18%) 0.568 0.02 Osteoporosis 8 (6%) 5 (7%) 3 (5%) 0.727 0.03 Dyslipidemia 29 (21%) 17 (23%) 12 (19%) 0.603 0.01 Malignant neoplasm 22 (16%) 12 (16%) 10 (16%) 0.984 0.00 Heart disease 31 (23%) 17 (23%) 14 (22%) 0.950 0.00 Chronic renal failure 12 (9%) 7 (9%) 5 (8%) 1.000 0.01 Others 46 (33%) 23 (31%) 23 (37%) 0.468 0.01 FIM total 73 [31–98] 89 [73–108] 35 [22–66] < 0.001 0.47 SPPB 4 [0–10] 8 [ 5 – 12 ] 0 [0–1] < 0.001 0.52 MMSE-J 20 [ 12 – 27 ] 25 [ 16 – 29 ] 12 [ 8 – 20 ] < 0.001 0.44 Possible Sarcopenia * 77 (63%) 32 (48%) 45 (82%) < 0.001 0.12 Calf circumference (cm) 29.4 ± 3.9 30.4 ± 3.6 28.0 ± 4.1 < 0.001 0.30 Handgrip (kg) 19.9 ± 9.8 23.7 ± 8.5 14.1 ± 8.9 < 0.001 0.48 Comparison of the clinical characteristics between the “Home discharge” group and the “Difficulty with discharge” group. Data are presented as the mean standard deviation and median [interquartile range]. MMSE-J: Mini-Mental state Examination-Japanese; SPPB: Short Physical Performance Battery. Student t test, Mann-Whitney U test, χ2-test, Fisher’s exact test. Effect size = Pearson’s correlation coefficient r or Cramer's V. *Sarcopenia determination excluded 16 patients due to missing values (8 persons in each group). Next, the ROC curve with the possibility of home discharge set as the state variable and CFS set as the test variable is shown in Fig. 2 . The CFS cut-off value was 6 or more, with a sensitivity of 70.7% and specificity of 84.1%. The AUC was 0.816, with a “good” prediction performance (Table 2 ). Table 2 Sensitivity and specificity cut-off value for CFS. CFS Cut-off value 5 / 6 P < 0.001 Sensitivity 71% Specificity 84% Maximum Youden index 0.55 Positive predictive value 74% Negative predictive value 82% AUC [95%CI] 0.82 [0.74–0.89] CFS: Clinical Frailty Scale; AUC: Area Under the Curve; CI: Confidence Interval In addition, logistic regression analysis was conducted with the possibility of home discharge as the dependent variable; CFS (score ≥ 6: 1) as the independent variable; and age, sex, BMI, serum albumin level, and possibility of sarcopenia as covariates, as these items were found to have significant differences in univariate analysis. Furthermore, significant inter-group differences were observed with dementia, FIM, SPPB, and MMSE-J in the univariate analysis; therefore, these items were excluded from the covariates as these might have multicollinearity with CFS (the Spearman's rank correlation coefficients (ρ) were 0.72, -0.87, -0.85, and − 0.76, respectively). The results are shown in Table 3 . There was a significant correlation between possibility of home discharge and CFS even after adjusting for covariates, with an odds ratio of 13.44 (95% Confidence Interval, 3.98–45.37), and the percentage of correct classifications was 81.6%. Table 3 Relation between home discharge and CFS in the COVID-19 treatment unit Unadjusted Adjusted OR (95%CI) P value OR (95%CI) P value CFS (< 6 = 0) Ref. Ref. CFS (≥ 6 = 1) 18.48 (6.95–49.18) < 0.001 13.44 (3.98–45.37) < 0.001 Logistic regression analysis CFS: Clinical Frailty Scale; OR: Odds Ratio; CI: Confidence Interval. Dependent variable: the home discharge group (0) or the difficulty with discharge group (1) Independent variable: CFS < 6 (0) or ≥ 6 (1) Covariate: Age, Sex, Body Mass Index, Albumin, Possible sarcopenia Percentage of correct classifications: 81.6% Ten patients could not be discharged home despite having a CFS score of less than 6. Almost all these patients were older people and had comorbidities that have been reported to heighten the risk of exacerbation when infected with COVID-19 (such as respiratory disease, diabetes, and cancer) [ 18 ], and the attending physician determined that continued hospitalisation was required for follow-up even after COVID-19 treatment had been completed. These patients were transferred to a normal ward for ongoing observation and rehabilitation. Conversely, there were 22 patients who were discharged home despite having CFS scores of 6 or higher. This included nine patients whose family members were well-equipped to care for them, and 13 patients without excessive care burden placed on the family due to use of home nursing care services, such as home-visit rehabilitation and day respite services, because these patients already required long-term care before admission with COVID-19. Discussion Topic sentences The following two points are noteworthy findings in this study. The first is that CFS is effective as a screening tool that can easily detect patients who require ongoing hospitalisation and rehabilitation intervention, even after the acute phase of treatment in a COVID-19 Treatment Unit. The second is that the study demonstrated that it was possible to predict with good accuracy whether a patient can be discharged directly to home based on the evaluation of the degree of frailty in the COVID-19 Treatment Unit. Usefulness of CFS Assessment CFS used for the evaluation of frailty in this study does not require any equipment, and is a screening tool that can be used by anyone, even in circumstances that require strict infection controls, such as personal protective equipment. Rockwood, who developed CFS, also pointed out the usefulness of patient triage using CFS under conditions with spread of infection [ 11 , 12 ]. SPPB and MMSE-J, which are used to evaluate physical and cognitive function, respectively, are similarly effective evaluation tools for screening and prognosis prediction [ 19 , 20 ]. In this study, these indices also correlated with the possibility of home discharge, but these evaluation tools require pre-training of evaluators and preparation of dedicated measurement equipment for use in the ward for infection control. On the other hand, CFS does not require any special training or equipment, it can be determined in a short timeframe based on medical information; it is an index for comprehensive evaluation of physical function, cognitive function, and ADL. Thus, especially in COVID-19 Treatment Units, CFS is considered superior to other evaluation methods. The severity of COVID-19 was mild or moderate I for approximately 70% of the patients in this study, and many of the patients were older people with a mean age of 82.7. Less than 20% of the patients were healthy without any frailty (CFS < 4), including physical and cognitive function. Patients admitted to COVID-19 Treatment Units during the spread of the Omicron variant were characteristically frail older people with various comorbidities, as seen in this study. An interesting finding in this study was that although the severity of SARS-CoV-2 infection ranged from mild to moderate I for the patients, no correlation was found between the severity of COVID-19 and the possibility of home discharge. This finding is consistent with the results of previous studies that found that cognitive function and ADL impairment had a stronger correlation with prognosis than the severity of SARS-CoV-2 infection in older patients (aged 80 years or older) [ 21 ]. The results of this study demonstrate the importance of paying attention not only to the severity of the COVID-19, but also to the degree of frailty, as well as the decline in ADL and cognitive function due to a reduction in activity associated with hospitalisation, in older patients with various comorbidities. Prediction of discharge with CFS As shown in the ROC analysis, the CFS cut-off value for predicting the possibility of home discharge directly from the COVID-19 Treatment Unit was 6, referring to moderate frailty. Furthermore, degree of frailty had a stronger effect on the possibility of home discharge than age, comorbidities, or severity of COVID-19, and the odds ratio that the direct home discharge would be difficult was more than 13 times greater for patients with moderate or higher frailty compared with patients without this level of frailty. It has been found that older people who required even a small amount of help with ADL within the home before admission were prone to disuse during the acute phase of treatment, and required ongoing hospitalisation after completion of treatment and rehabilitation intervention, even if the severity of COVID-19 was relatively mild [ 22 , 23 ]. However, there were patients who could be discharged home even with moderate to severe frailty, depending on environmental and social factors such as use of public nursing care services from before the onset of COVID-19 and family members being well-equipped to care for the patients after their return. This study was conducted during the spread of the Omicron variant, said to be an attenuated virus strain more contagious than the Delta variant but with a reduced mortality rate [ 24 ]. However, the findings of the study demonstrated that when treating COVID-19 in older patients with moderate to severe frailty, the reduction in activity during the acute isolation period poses a risk of decline in ADL and onset of disuse syndrome, which are factors that impede the patients’ ability to return home. Therefore, it is important to implement appropriate physical rehabilitation and nutritional intervention [ 25 ] and consider therapeutic measures that aim to maintain or improve ADL, in view of social rehabilitation, from the initial stages of hospitalisation during the acute phase of treatment, to promote home discharge and social rehabilitation soon after completing treatment. Practicing excessive self-restraint against going out and participation in activities by older people living in the community reduces the opportunity for social interaction and increases the risk of reduced mental and physical function [ 26 , 27 ]. The risk of a decline in life functions due to rest and reduced activity is particularly high in older people who are frail and require long-term care and have decreased physical and cognitive function [ 28 , 29 ], making focused rehabilitation intervention essential from an early stage [ 6 ]. Most regions throughout the world have adopted a “living with COVID-19” strategy, and the world is slowly returning to pre-COVID-19 life as much as possible. Indeed, the risk of developing severe illness from SARS-CoV-2 infection is certainly lower than that at the start of the pandemic in 2020. However, as shown in this study, when considering saving a person’s life as well as discharging them home to help them to return to their own life, it should be borne in mind that the risks posed by infection are not necessarily low for frail older people with various comorbidities. The Asian Working Group for Sarcopenia 2019 has advocated the importance of striking a balance between preventing COVID-19 and maintaining function [ 30 ], and it is good to consider ways for frail older people to live their lives while maintaining a balance between infection control and activity, while also preventing the progression of frailty. Study Limitations This study had several limitations. First, this study was conducted for a limited period within a single facility. The prognosis is unknown if new variants of SARS-CoV-2 are encountered in the future. Therefore, these results cannot be generalised for all patients with COVID-19, and it is necessary to conduct further investigations in multiple facilities with different degrees of severity to ascertain if the trends seen in this study are unique to patients with mild to moderate COVID-19, infected with the Omicron variant. Next, this was a cross-sectional study that used the results of evaluation at a fixed timepoint implemented approximately 5 days after onset, once the fever had abated and the patient’s condition had stabilised. Therefore, the study did not fully evaluate the degree of progression of frailty due to bed rest after hospitalisation. However, the finding that the degree of frailty at initial evaluation has a significant effect on prognosis is very important, and evaluating frailty is useful for predicting outcomes after completing the acute phase of treatment and for establishing measures. Currently, it is necessary to follow-up the progress of patients who had difficulty in discharging directly to home and to clarify the effect of rehabilitation intervention and the long-term impact of COVID-19 on ADL in older people. Conclusion This study investigated the characteristics of patients admitted to a COVID-19 Treatment Unit during the spread of the Omicron variant, and considered the correlation between frailty and home discharge, as well as the usefulness of frailty evaluation as a prognostic prediction. It has been shown that CFS is useful as a screening tool that can determine the necessity of continued hospitalisation after the end of the acute phase of treatment, with a relatively high degree of sensitivity and specificity. When patients have moderate to severe frailty, isolation and reduced activity in a COVID-19 Treatment Unit are considered factors that hinder the patients return to home. It is important to consider measures aiming to maintain or improve ADL from an early stage, to enable social rehabilitation soon after completing treatment. List Of Abbreviations COVID-19: coronavirus disease 2019; ADL: Activities of Daily Living; CFS: Clinical Frailty Scale; BMI: Body mass index; FIM: Functional Independent Measure; SPPB: Short Physical Performance Battery; MMSE-J: Mini Mental State Examination-Japanese; ROC: Receiver Operating Characteristic; AUC: Area Under the Curve; CI: Confidence Interval; OR: Odds Ratio. Declarations Ethics approval and consent to participate The study protocol complied with the Declaration of Helsinki. The study is a retrospective study, instead of obtaining individual informed consent from the participants, a public information disclosure document was published to inform the participants of their rights to inquire about and refuse the content of the study. The informed consent has been approved by the ethics committee of the National Center for Geriatric and Gerontology, and that ethics review board approved the study (approval no. 1582-2). Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. Competing interests The authors declare no conflict of interest. Funding This study was supported by The Research Funding for Longevity sciences (21-37) from National Center for Geriatrics and Gerontology (NCGG), Japan. No financial disclosures were reported by all authors. The funding body had no roles in the study design, data collection, data analysis, and interpretation, or report writing. Author’s contributions Study concept and design: KK, AO, and TM. Investigation, methodology, and project administration: KK, MT, HK, and TM. Data analysis and interpretation: KK and MT. Statistical analysis: KK. Drafting of the manuscript: KK, and AO. Critical revision of the manuscript: KK, AO, HK, and HA. All authors reviewed the manuscript and agreed with the submission. 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Evans SJ, Sayers M, Mitnitski A, Rockwood K. The risk of adverse outcomes in hospitalized older patients in relation to a frailty index based on a comprehensive geriatric assessment. Age Aging. 2014;43(1):127–32. 10.1093/ageing/aft156 . Bouzid D, Visseaux B, Kassasseya C, Daoud A, Fémy F, Hermand C, et al. Comparison of Patients Infected With Delta Versus Omicron COVID-19 Variants Presenting to Paris Emergency Departments: A Retrospective Cohort Study. Ann Intern Med. 2022;M22–0308. 10.7326/M22-0308 . Pranata R, Henrina J, Lim MA, Lawrensia S, Yonas E, Vania R, et al. Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis. Arch Gerontol Geriatr. 2021;93:104324. 10.1016/j.archger.2020.104324 . Yamada M, Kimura Y, Ishiyama D, Otobe Y, Suzuki M, Koyama S, 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):751–6. 10.1007/s12603-021-1634-2 . Kawamura K, Kamiya M, Suzumura S, Maki K, Ueda I, Itoh N, et al. Impact of the coronavirus disease 2019 outbreak on activity and exercise levels among older patients. J Nutr Health Aging. 2021;25(7):921–5. 10.1007/s12603-021-1648-9 . Kiely DK, Cupples LA, Lipsitz LA. Validation and comparison of two frailty indexes: The MOBILIZE Boston Study. J Am Geriatr Soc. 2009;57(9):1532–9. 10.1111/j.1532-5415.2009.02394.x . Vermeulen J, Spreeuwenberg MD, Daniëls R, Neyens JC, Rossum EV, Witte LP. Does a falling level of activity predict disability development in community-dwelling elderly people? Clin Rehabil. 2013;27(6):546–54. 10.1177/0269215512465209 . Lim WS, Liang CK, Assantachai P, Auyeung TW, Kang L, Lee WJ, et al. COVID-19 and older people in Asia: Asian Working Group for Sarcopenia calls to actions. Geriatr Gerontol Int. 2020;20(6):547–58. 10.1111/ggi.13939 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 12 Jul, 2023 Read the published version in BMC Geriatrics → Version 1 posted Editorial decision: Major revision 30 May, 2023 Reviews received at journal 29 May, 2023 Reviewers agreed at journal 26 May, 2023 Reviews received at journal 23 Apr, 2023 Reviewers agreed at journal 12 Apr, 2023 Reviewers invited by journal 12 Apr, 2023 Editor assigned by journal 12 Apr, 2023 Editor invited by journal 07 Apr, 2023 Submission checks completed at journal 07 Apr, 2023 First submitted to journal 22 Mar, 2023 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2722719","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":189956056,"identity":"104f025e-5452-4671-84e4-03a1e70b4378","order_by":0,"name":"Koki Kawamura","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2ElEQVRIiWNgGAWjYBACCRiDHyF2gEgtkg0kazEgoBABJNvPGH662XZP3vh28+OXXxhq5RgYz+LXLc2TYyyd21ZsuO3OMTNrGYbjxgwM5xLwapFjyN0A1JLAuO1GDpuxBMOxxAaGMwb4tfC/3fwbqMV+8wxitUhL5G4D2ZK4QSKH+eEHhhrCWiRnvP9mnXMuIXnGjTQzZmC4GbMR8ovE+bTk2zllCbb9M5Iff/xRUSfHL0EgxJABmzSPwWEGNokzROtgYP74g6EOmHR6iNcyCkbBKBgFIwIAAFoDSNnDk2vqAAAAAElFTkSuQmCC","orcid":"","institution":"National Center for Geriatrics and Gerontology","correspondingAuthor":true,"prefix":"","firstName":"Koki","middleName":"","lastName":"Kawamura","suffix":""},{"id":189956057,"identity":"6a6c648b-fd1b-45a1-b7c9-91107f634e6d","order_by":1,"name":"Aiko Osawa","email":"","orcid":"","institution":"National Center for Geriatrics and Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Aiko","middleName":"","lastName":"Osawa","suffix":""},{"id":189956058,"identity":"e866c124-1887-4eb1-aa23-818d812045e2","order_by":2,"name":"Masanori Tanimoto","email":"","orcid":"","institution":"National Center for Geriatrics and Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Masanori","middleName":"","lastName":"Tanimoto","suffix":""},{"id":189956059,"identity":"e4ed52c6-40d0-45a7-a9e5-c7e1fe8b3432","order_by":3,"name":"Hitoshi Kagaya","email":"","orcid":"","institution":"National Center for Geriatrics and Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Hitoshi","middleName":"","lastName":"Kagaya","suffix":""},{"id":189956060,"identity":"a91f5a6b-b1a9-47c2-9efd-d6a7a79e026a","order_by":4,"name":"Toshihiro Matsuura","email":"","orcid":"","institution":"National Center for Geriatrics and Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Toshihiro","middleName":"","lastName":"Matsuura","suffix":""},{"id":189956061,"identity":"0077e266-811b-45d5-b481-3f04a9d5b15f","order_by":5,"name":"Hidenori Arai","email":"","orcid":"","institution":"National Center for Geriatrics and Gerontology","correspondingAuthor":false,"prefix":"","firstName":"Hidenori","middleName":"","lastName":"Arai","suffix":""}],"badges":[],"createdAt":"2023-03-22 11:29:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2722719/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2722719/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-023-04133-4","type":"published","date":"2023-07-13T01:08:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":35601124,"identity":"27090970-75cc-4edc-8c8a-fe967532c1fc","added_by":"auto","created_at":"2023-04-11 18:04:37","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":126499,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of Clinical Frailty Scale scores in study participants.\u003c/p\u003e\n\u003cp\u003eThe “Home discharge” group and the “Difficulty with discharge” group described, respectively.\u003c/p\u003e\n\u003cp\u003eHome discharge group: Patient who could be discharged directly home after completing the acute phase of COVID-19 treatment.\u003c/p\u003e\n\u003cp\u003eDifficulty with discharge group: Patient who continued to be hospitalized and required rehabilitation.\u003c/p\u003e\n\u003cp\u003eMann-Whitney U test, P\u0026lt;0.001, Effect size (Pearson’s correlation coefficient r) = -0.55\u003c/p\u003e","description":"","filename":"Figure1.DistributionofClinicalFrailtyScalescoresinstudyparticipants..jpg","url":"https://assets-eu.researchsquare.com/files/rs-2722719/v1/b98613913ad315c1119866f8.jpg"},{"id":35601123,"identity":"f240427a-60b8-4002-bf28-3e78469bb4b4","added_by":"auto","created_at":"2023-04-11 18:04:37","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":57686,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic curves.\u003c/p\u003e\n\u003cp\u003eROC curves for cut-off values of CFS scores for possible return home directly from COVID-19 Treatment Unit.\u003c/p\u003e","description":"","filename":"Figure2.Receiveroperatingcharacteristiccurves..jpg","url":"https://assets-eu.researchsquare.com/files/rs-2722719/v1/ce8677873ae4fabff081aa2d.jpg"},{"id":41740221,"identity":"8d977571-8c3a-4e6b-b346-ebc6c5a55c9d","added_by":"auto","created_at":"2023-08-18 04:20:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":402217,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2722719/v1/5081c441-741d-43dd-8235-b2cba8d12bb3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Frailty Scale is useful in predicting return-to-home in patients admitted due to coronavirus disease","fulltext":[{"header":"Background","content":"\u003cp\u003eThe spread of the novel coronavirus disease 2019 (COVID-19) has been explosive. As of 2023, it still has not been contained, and its effects are prolonged in various countries throughout the world [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Japan, the highly contagious Omicron variant became widespread from January 2022, and there have been repeated waves of infection, called the 6th, 7th, and 8th waves, where the number of infected people rapidly increased followed by a fall in the number of infected [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although this variant is more contagious than that at the beginning of the pandemic, the ratio of deaths to infected persons is falling [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, the risk of the infection turning severe remains high among the older and people with comorbidities [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. High risk patients and those with highly contagious symptoms are admitted to medical institutions to prevent the spread of infection and the infection becoming more severe.\u003c/p\u003e \u003cp\u003eThe National Center for Geriatrics and Gerontology (our centre) opened a dedicated ward for patients with COVID-19 (COVID-19 Treatment Unit), and the ward mainly admitted and treated older patients with comorbidities considered to have mild to moderate symptoms. In the COVID-19 Treatment Unit in this centre, preparations for discharge were generally conducted from 10 days after onset. However, many patients could not be immediately discharged to home despite completion of the acute phase of the COVID-19 treatment, due to a decline in Activities of Daily Living (ADL) caused by disuse during treatment. The influencing factors for this phenomenon are thought to be the advanced age of the patients and the existence of comorbidities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], but there are insufficient findings on which kind of patients tend to be difficult to discharge. As a result of preliminary analysis of data of patients admitted to the COVID-19 Treatment Unit in this centre from January to March 2022, we realised that there may be a correlation between frailty and home discharge [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, there are few reports on COVID-19 and frailty.\u003c/p\u003e \u003cp\u003eIn this study, we established a hypothesis based on past findings, namely, evaluating the degree of frailty in patients positive for COVID-19 might help to predict whether a patient could be discharged from the COVID-19 Treatment Unit directly to home after completion of the acute phase of treatment. If it is possible to predict cases that are highly likely to be difficult to discharge home from as soon as the early stage of COVID-19 treatment, then providing early and focused rehabilitation to these patients to improve their ADL may be beneficial for preventing disuse during hospitalisation, thereby promoting prompt discharge and return to normal life after treatment [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, this study aimed to investigate the relationship between the degree of frailty and home discharge of patients admitted to the COVID-19 Treatment Unit.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipation\u003c/h2\u003e \u003cp\u003eOf the 231 patients admitted to the COVID-19 Treatment Unit in this centre with positive COVID-19 PCR test results during the 12-month period from January to December 2022, 138 patients (men, n\u0026thinsp;=\u0026thinsp;85; women, n\u0026thinsp;=\u0026thinsp;53) were included in the analysis (excluding 16 patients younger than 65 years, 35 patients with hospital-acquired infections, 37 patients who were originally residents of nursing homes, and five patients with severe infections). The in-hospital medical record shown below was retrospectively examined for patients included in the analysis.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAssessment\u003c/h3\u003e\n\u003cp\u003eThe endpoint was whether the patient could be discharged from the COVID-19 Treatment Unit directly to home, and the patients were classified into two groups: patients who were able to be discharged directly to home after completion of the acute phase of the COVID-19 treatment (Home discharge group) and patients who continued to stay in the hospital and required rehabilitation to be discharged home (Difficulty in discharge group).\u003c/p\u003e \u003cp\u003eThe degree of frailty, as the main item for evaluating the correlation with the endpoint, was determined using the Clinical Frailty Scale (CFS), Japanese version (translated by The Japan Geriatrics Society, 2021). CFS is a comprehensive index for evaluating the degree of frailty on a 9-point scale, proposed by Rockwood et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The scale allocates a high score for decline in both physical and cognitive functions, because the determination considers the level of independence in activities of daily living and the need for nursing care. The evaluation does not require equipment or a long period of time, and CFS is a simple index able to make a comprehensive judgement based on clinical findings [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which gives it the advantage of being easy to use under conditions that require special infection controls such as COVID-19 Treatment Units.\u003c/p\u003e \u003cp\u003eAge, sex, body mass index (BMI), serum albumin level, severity of COVID-19, comorbidities, Activities of Daily Living ADL (Functional Independent Measure, FIM), sarcopenia (calf circumference, grip strength), physical function (Short Physical Performance Battery, SPPB), and cognitive function (Mini Mental State Examination-Japanese, MMSE-J) were examined as secondary endpoints.\u003c/p\u003e \u003cp\u003eThe severity of COVID-19 was classified based on the Ministry of Health, Labour and Welfare criteria [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] as the following: mild, SpO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026ge;\u0026thinsp;96% and no respiratory symptoms; moderate I, 93%\u0026lt;SpO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;96% and dyspnoea or pneumonia findings; and moderate II, requires oxygen therapy with SpO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;93%. Patients with a calf circumference of \u0026lt;\u0026thinsp;43 cm for men/\u0026lt;33 cm for women, and a grip strength of \u0026lt;\u0026thinsp;28 kg for men/\u0026lt;18 kg for women were determined to have \u0026ldquo;possible sarcopenia\u0026rdquo; in accordance with the AWGS 2019 criteria for sarcopenia [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. SPPB is a simple but comprehensive physical function assessment battery that allocates a score of 0 to 12 by testing three items: 4 m walk, the chair stand test completed 5 times, and the standing balance test; the higher the score, the better the motor function [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. MMSE-J is the Japanese version of a cognitive function test battery, based on MMSE [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], which can be conducted relatively easily and allocates a score from 0 to 30; the higher the score, the better the cognitive function [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese evaluations were conducted approximately 5 days after onset, once it was confirmed that the fever had abated, on the day when the in-ward rehabilitation started with the permission and determination of the attending physician. All medical staff involved in the dedicated COVID-19 Treatment Unit complied with infection control measures in accordance with the instructions of the Infection Control Committee.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe Student t-test, Mann-Whitney U-test, χ\u003csup\u003e2\u003c/sup\u003e-test, and Fisher\u0026rsquo;s exact test were used for comparison of the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and median [interquartile range] or percentage (%) descriptions for each endpoint, and for comparison of the possibility of home discharge and each endpoint. An Receiver Operating Characteristic (ROC) curve was created with the possibility of home discharge set as the state variable and CFS set as the test variable, and the cut-off value was calculated at the maximum value of sensitivity, specificity, area under the curve (AUC), and the Youden index. Furthermore, logistic regression analysis was conducted with the possibility of home discharge (Difficult Group\u0026thinsp;=\u0026thinsp;1) set as the dependent variable and CFS (binary variable at or above/below the Cut-off) as the independent variable. Spearman's rank correlation coefficient was used to diagnose multicollinearity between covariates.\u003c/p\u003e \u003cp\u003eSPSS Ver. 28.0 was used for statistical analysis and the level of significance was set at 1%.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThere were no cases of infection among the medical staff in the dedicated COVID-19 Treatment Unit during the survey period, indicating that it is possible to safely provide medical care, nursing, and rehabilitation during the isolation period by adopting appropriate measures. The mean number of days spent in the ward by the 138 patients in the study was 11.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 days, and the severity of COVID-19 at admission was mild for 58 patients, moderate I for 47, and moderate II for 32. There were 75 patients in the Home discharge group, and 63 patients in the Difficulty in discharge group. The number of people able to be discharged home using the CFS score is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The median (interquartile range) CFS score was 5 (3\u0026ndash;6) in the Home discharge group and 7 (6\u0026ndash;7) in the Difficulty in discharge group, and the number of cases that were difficult to discharge increased with the CFS score (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001, effect size=-0.55).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the results of comparison of each secondary endpoint based on the possibility of home discharge. In the intergroup comparison based on the possibility of home discharge, advanced age, female sex, low BMI, low serum albumin levels, dementia, low total FIM score, reduced calf circumference, low grip strength, possible sarcopenia, low SPPB, and low MMSE-J made discharging to home significantly more difficult. The severity of COVID-19 and the presence/absence of other comorbidities were not associated with the possibility of home discharge.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the clinical characteristics between the \"Home discharge\" group and the \"Difficulty with discharge\" group.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;138\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;138)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHome discharge group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDifficulty with discharge group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEffect size\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82.7\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.0\u0026thinsp;\u0026plusmn;\u0026thinsp;8.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.27\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex_Female\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e53 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeverity of COVID-19 - Mild\u003c/p\u003e \u003cp\u003e- Moderate Ⅰ\u003c/p\u003e \u003cp\u003e- Moderate Ⅱ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58 (42%)\u003c/p\u003e \u003cp\u003e47 (34%)\u003c/p\u003e \u003cp\u003e33 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (44%)\u003c/p\u003e \u003cp\u003e29 (39%)\u003c/p\u003e \u003cp\u003e13 (17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (40%)\u003c/p\u003e \u003cp\u003e18 (28%)\u003c/p\u003e \u003cp\u003e20 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eComorbidities (include duplicates)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCerebrovascular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespiratory disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26 (35%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeuromuscular disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (59%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e53 (84%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52 (38%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOsteoporosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.727\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDyslipidemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (21%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.603\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalignant neoplasm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeart disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChronic renal failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFIM total\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 [31\u0026ndash;98]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89 [73\u0026ndash;108]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 [22\u0026ndash;66]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSPPB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 [0\u0026ndash;10]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 [\u003cspan additionalcitationids=\"CR6 CR7 CR8 CR9 CR10 CR11\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 [0\u0026ndash;1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMMSE-J\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 [\u003cspan additionalcitationids=\"CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25 [\u003cspan additionalcitationids=\"CR17 CR18 CR19 CR20 CR21 CR22 CR23 CR24 CR25 CR26 CR27 CR28\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 [\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossible Sarcopenia *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e77 (63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (82%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalf circumference (cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHandgrip (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19.9\u0026thinsp;\u0026plusmn;\u0026thinsp;9.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.1\u0026thinsp;\u0026plusmn;\u0026thinsp;8.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eComparison of the clinical characteristics between the \u0026ldquo;Home discharge\u0026rdquo; group and the \u0026ldquo;Difficulty with discharge\u0026rdquo; group.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eData are presented as the mean standard deviation and median [interquartile range].\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eMMSE-J: Mini-Mental state Examination-Japanese; SPPB: Short Physical Performance Battery.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eStudent t test, Mann-Whitney U test, χ2-test, Fisher\u0026rsquo;s exact test. Effect size\u0026thinsp;=\u0026thinsp;Pearson\u0026rsquo;s correlation coefficient r or Cramer's V.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e*Sarcopenia determination excluded 16 patients due to missing values (8 persons in each group).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eNext, the ROC curve with the possibility of home discharge set as the state variable and CFS set as the test variable is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The CFS cut-off value was 6 or more, with a sensitivity of 70.7% and specificity of 84.1%. The AUC was 0.816, with a \u0026ldquo;good\u0026rdquo; prediction performance (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSensitivity and specificity cut-off value for CFS.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCFS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCut-off value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 / 6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSensitivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecificity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum Youden index\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive predictive value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative predictive value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAUC [95%CI]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.82 [0.74\u0026ndash;0.89]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003eCFS: Clinical Frailty Scale; AUC: Area Under the Curve; CI: Confidence Interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn addition, logistic regression analysis was conducted with the possibility of home discharge as the dependent variable; CFS (score\u0026thinsp;\u0026ge;\u0026thinsp;6: 1) as the independent variable; and age, sex, BMI, serum albumin level, and possibility of sarcopenia as covariates, as these items were found to have significant differences in univariate analysis. Furthermore, significant inter-group differences were observed with dementia, FIM, SPPB, and MMSE-J in the univariate analysis; therefore, these items were excluded from the covariates as these might have multicollinearity with CFS (the Spearman's rank correlation coefficients (ρ) were 0.72, -0.87, -0.85, and \u0026minus;\u0026thinsp;0.76, respectively). The results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. There was a significant correlation between possibility of home discharge and CFS even after adjusting for covariates, with an odds ratio of 13.44 (95% Confidence Interval, 3.98\u0026ndash;45.37), and the percentage of correct classifications was 81.6%.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelation between home discharge and CFS in the COVID-19 treatment unit\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnadjusted\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAdjusted\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFS (\u0026lt;\u0026thinsp;6 =\u0026thinsp;0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCFS (\u0026ge;\u0026thinsp;6 =\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.48 (6.95\u0026ndash;49.18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13.44 (3.98\u0026ndash;45.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eLogistic regression analysis\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCFS: Clinical Frailty Scale; OR: Odds Ratio; CI: Confidence Interval.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eDependent variable: the home discharge group (0) or the difficulty with discharge group (1)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eIndependent variable: CFS\u0026thinsp;\u0026lt;\u0026thinsp;6 (0) or \u0026ge;\u0026thinsp;6 (1)\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCovariate: Age, Sex, Body Mass Index, Albumin, Possible sarcopenia\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003ePercentage of correct classifications: 81.6%\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTen patients could not be discharged home despite having a CFS score of less than 6. Almost all these patients were older people and had comorbidities that have been reported to heighten the risk of exacerbation when infected with COVID-19 (such as respiratory disease, diabetes, and cancer) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], and the attending physician determined that continued hospitalisation was required for follow-up even after COVID-19 treatment had been completed. These patients were transferred to a normal ward for ongoing observation and rehabilitation. Conversely, there were 22 patients who were discharged home despite having CFS scores of 6 or higher. This included nine patients whose family members were well-equipped to care for them, and 13 patients without excessive care burden placed on the family due to use of home nursing care services, such as home-visit rehabilitation and day respite services, because these patients already required long-term care before admission with COVID-19.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTopic sentences\u003c/h2\u003e \u003cp\u003eThe following two points are noteworthy findings in this study.\u003c/p\u003e \u003cp\u003eThe first is that CFS is effective as a screening tool that can easily detect patients who require ongoing hospitalisation and rehabilitation intervention, even after the acute phase of treatment in a COVID-19 Treatment Unit. The second is that the study demonstrated that it was possible to predict with good accuracy whether a patient can be discharged directly to home based on the evaluation of the degree of frailty in the COVID-19 Treatment Unit.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eUsefulness of CFS Assessment\u003c/h3\u003e\n\u003cp\u003eCFS used for the evaluation of frailty in this study does not require any equipment, and is a screening tool that can be used by anyone, even in circumstances that require strict infection controls, such as personal protective equipment. Rockwood, who developed CFS, also pointed out the usefulness of patient triage using CFS under conditions with spread of infection [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. SPPB and MMSE-J, which are used to evaluate physical and cognitive function, respectively, are similarly effective evaluation tools for screening and prognosis prediction [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In this study, these indices also correlated with the possibility of home discharge, but these evaluation tools require pre-training of evaluators and preparation of dedicated measurement equipment for use in the ward for infection control. On the other hand, CFS does not require any special training or equipment, it can be determined in a short timeframe based on medical information; it is an index for comprehensive evaluation of physical function, cognitive function, and ADL. Thus, especially in COVID-19 Treatment Units, CFS is considered superior to other evaluation methods.\u003c/p\u003e \u003cp\u003eThe severity of COVID-19 was mild or moderate I for approximately 70% of the patients in this study, and many of the patients were older people with a mean age of 82.7. Less than 20% of the patients were healthy without any frailty (CFS\u0026thinsp;\u0026lt;\u0026thinsp;4), including physical and cognitive function. Patients admitted to COVID-19 Treatment Units during the spread of the Omicron variant were characteristically frail older people with various comorbidities, as seen in this study. An interesting finding in this study was that although the severity of SARS-CoV-2 infection ranged from mild to moderate I for the patients, no correlation was found between the severity of COVID-19 and the possibility of home discharge. This finding is consistent with the results of previous studies that found that cognitive function and ADL impairment had a stronger correlation with prognosis than the severity of SARS-CoV-2 infection in older patients (aged 80 years or older) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The results of this study demonstrate the importance of paying attention not only to the severity of the COVID-19, but also to the degree of frailty, as well as the decline in ADL and cognitive function due to a reduction in activity associated with hospitalisation, in older patients with various comorbidities.\u003c/p\u003e\n\u003ch3\u003ePrediction of discharge with CFS\u003c/h3\u003e\n\u003cp\u003eAs shown in the ROC analysis, the CFS cut-off value for predicting the possibility of home discharge directly from the COVID-19 Treatment Unit was 6, referring to moderate frailty. Furthermore, degree of frailty had a stronger effect on the possibility of home discharge than age, comorbidities, or severity of COVID-19, and the odds ratio that the direct home discharge would be difficult was more than 13 times greater for patients with moderate or higher frailty compared with patients without this level of frailty. It has been found that older people who required even a small amount of help with ADL within the home before admission were prone to disuse during the acute phase of treatment, and required ongoing hospitalisation after completion of treatment and rehabilitation intervention, even if the severity of COVID-19 was relatively mild [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, there were patients who could be discharged home even with moderate to severe frailty, depending on environmental and social factors such as use of public nursing care services from before the onset of COVID-19 and family members being well-equipped to care for the patients after their return.\u003c/p\u003e \u003cp\u003eThis study was conducted during the spread of the Omicron variant, said to be an attenuated virus strain more contagious than the Delta variant but with a reduced mortality rate [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. However, the findings of the study demonstrated that when treating COVID-19 in older patients with moderate to severe frailty, the reduction in activity during the acute isolation period poses a risk of decline in ADL and onset of disuse syndrome, which are factors that impede the patients\u0026rsquo; ability to return home. Therefore, it is important to implement appropriate physical rehabilitation and nutritional intervention [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and consider therapeutic measures that aim to maintain or improve ADL, in view of social rehabilitation, from the initial stages of hospitalisation during the acute phase of treatment, to promote home discharge and social rehabilitation soon after completing treatment.\u003c/p\u003e \u003cp\u003ePracticing excessive self-restraint against going out and participation in activities by older people living in the community reduces the opportunity for social interaction and increases the risk of reduced mental and physical function [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The risk of a decline in life functions due to rest and reduced activity is particularly high in older people who are frail and require long-term care and have decreased physical and cognitive function [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], making focused rehabilitation intervention essential from an early stage [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Most regions throughout the world have adopted a \u0026ldquo;living with COVID-19\u0026rdquo; strategy, and the world is slowly returning to pre-COVID-19 life as much as possible. Indeed, the risk of developing severe illness from SARS-CoV-2 infection is certainly lower than that at the start of the pandemic in 2020. However, as shown in this study, when considering saving a person\u0026rsquo;s life as well as discharging them home to help them to return to their own life, it should be borne in mind that the risks posed by infection are not necessarily low for frail older people with various comorbidities. The Asian Working Group for Sarcopenia 2019 has advocated the importance of striking a balance between preventing COVID-19 and maintaining function [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and it is good to consider ways for frail older people to live their lives while maintaining a balance between infection control and activity, while also preventing the progression of frailty.\u003c/p\u003e\n\u003ch3\u003eStudy Limitations\u003c/h3\u003e\n\u003cp\u003eThis study had several limitations. First, this study was conducted for a limited period within a single facility. The prognosis is unknown if new variants of SARS-CoV-2 are encountered in the future. Therefore, these results cannot be generalised for all patients with COVID-19, and it is necessary to conduct further investigations in multiple facilities with different degrees of severity to ascertain if the trends seen in this study are unique to patients with mild to moderate COVID-19, infected with the Omicron variant.\u003c/p\u003e \u003cp\u003eNext, this was a cross-sectional study that used the results of evaluation at a fixed timepoint implemented approximately 5 days after onset, once the fever had abated and the patient\u0026rsquo;s condition had stabilised. Therefore, the study did not fully evaluate the degree of progression of frailty due to bed rest after hospitalisation. However, the finding that the degree of frailty at initial evaluation has a significant effect on prognosis is very important, and evaluating frailty is useful for predicting outcomes after completing the acute phase of treatment and for establishing measures. Currently, it is necessary to follow-up the progress of patients who had difficulty in discharging directly to home and to clarify the effect of rehabilitation intervention and the long-term impact of COVID-19 on ADL in older people.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study investigated the characteristics of patients admitted to a COVID-19 Treatment Unit during the spread of the Omicron variant, and considered the correlation between frailty and home discharge, as well as the usefulness of frailty evaluation as a prognostic prediction. It has been shown that CFS is useful as a screening tool that can determine the necessity of continued hospitalisation after the end of the acute phase of treatment, with a relatively high degree of sensitivity and specificity. When patients have moderate to severe frailty, isolation and reduced activity in a COVID-19 Treatment Unit are considered factors that hinder the patients return to home. It is important to consider measures aiming to maintain or improve ADL from an early stage, to enable social rehabilitation soon after completing treatment.\u003c/p\u003e"},{"header":"List Of Abbreviations","content":"\u003cp\u003eCOVID-19: coronavirus disease 2019; ADL: Activities of Daily Living; CFS: Clinical Frailty Scale; BMI: Body mass index; FIM: Functional Independent Measure; SPPB: Short Physical Performance Battery; MMSE-J: Mini Mental State Examination-Japanese; ROC: Receiver Operating Characteristic; AUC: Area Under the Curve; CI: Confidence Interval; OR: Odds Ratio.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe study protocol complied with the Declaration of Helsinki. The study is a retrospective study, instead of obtaining individual informed consent from the participants, a public information disclosure document was published to inform the participants of their rights to inquire about and refuse the content of the study. The informed consent has been approved by the ethics committee of the National Center for Geriatric and Gerontology, and that ethics review board approved the study (approval no. 1582-2).\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThis study was supported by The Research Funding for Longevity sciences (21-37) from National Center for Geriatrics and Gerontology (NCGG), Japan. No financial disclosures were reported by all authors. The funding body had no roles in the study design, data collection, data analysis, and interpretation, or report writing.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eStudy concept and design: KK, AO, and TM.\u003c/p\u003e\u003cp\u003eInvestigation, methodology, and project administration: KK, MT, HK, and TM.\u003c/p\u003e\u003cp\u003eData analysis and interpretation: KK and MT.\u003c/p\u003e\u003cp\u003eStatistical analysis: KK.\u003c/p\u003e\u003cp\u003eDrafting of the manuscript: KK, and AO.\u003c/p\u003e\u003cp\u003eCritical revision of the manuscript: KK, AO, HK, and HA.\u003c/p\u003e\u003cp\u003eAll authors reviewed the manuscript and agreed with the submission.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWe are grateful to the patients, physicians, and all staff members of the National Center for Geriatrics and Gerontology, including the COVID-19 Treatment Unit, for their cooperation in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. 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J Am Geriatr Soc. 2009;57(9):1532\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/j.1532-5415.2009.02394.x\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003cli\u003eVermeulen J, Spreeuwenberg MD, Dani\u0026euml;ls R, Neyens JC, Rossum EV, Witte LP. Does a falling level of activity predict disability development in community-dwelling elderly people? Clin Rehabil. 2013;27(6):546\u0026ndash;54. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0269215512465209\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003cli\u003eLim WS, Liang CK, Assantachai P, Auyeung TW, Kang L, Lee WJ, et al. COVID-19 and older people in Asia: Asian Working Group for Sarcopenia calls to actions. Geriatr Gerontol Int. 2020;20(6):547\u0026ndash;58. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/ggi.13939\u003c/span\u003e\u003c/span\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Frailty, Predicts discharge, Epidemic.","lastPublishedDoi":"10.21203/rs.3.rs-2722719/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2722719/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe spread of the novel SARS-CoV-2 infection prolonged, and the highly contagious Omicron variant became the predominant variant by 2022. Many patients admitted to dedicated coronavirus disease 2019 (COVID-19) wards (COVID-19 Treatment Units) develop disuse syndrome while being treated in hospital, and their ability to perform activities of daily living decline, making it difficult for hospitals to discharge such patients. This study aimed to investigate the relationship between the degree of frailty and home discharge of patients admitted to a COVID-19 Treatment Unit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study retrospectively examined the in-patient medical records of 138 patients (82.7±7.6 years) admitted to a COVID-19 Treatment Unit from January to December 2022. The endpoint was whether the patients were able to be discharged from the COVID-19 Treatment Unit directly to home, and were classified into the Home discharge group, compared with the Difficulty in discharge group. The degree of frailty was determined based on Clinical Frailty Scale (CFS), and the relationship with the endpoint was analysed. A Receiver Operating Characteristic (ROC) curve was created and the cut-off value was calculated with the possibility of home discharge set as the state variable and CFS set as the test variable. Logistic regression analysis was conducted with the possibility of home discharge set as the dependent variable and CFS as the independent variable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere were 75 patients in the Home discharge group, and 63 patients in the Difficulty in discharge group. As a result of ROC analysis, the CFS cut-off value was 6 or more, with a sensitivity of 70.7% and specificity of 84.1%. The results of logistic regression analysis showed a significant correlation between possibility of home discharge and CFS even after adjusting for covariates, with an odds ratio of 13.44.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIt was possible to predict with good accuracy whether a patient could be discharged directly to home after treatment based on the evaluation of the degree of frailty in the COVID-19 Treatment Unit. CFS is effective as a screening tool that can easily detect patients who require ongoing hospitalisation even after the acute phase of treatment in the COVID-19 Treatment Unit.\u003c/p\u003e","manuscriptTitle":"Clinical Frailty Scale is useful in predicting return-to-home in patients admitted due to coronavirus disease","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-04-11 18:04:32","doi":"10.21203/rs.3.rs-2722719/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major revision","date":"2023-05-30T10:47:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-05-29T10:14:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2091ac97-bd6e-4418-be79-b20d1422ebcd","date":"2023-05-26T10:30:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2023-04-23T18:16:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"28ededc6-4448-44dd-a76b-f6a6088d20f2","date":"2023-04-12T17:55:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-04-12T17:50:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-04-12T17:30:06+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-04-07T09:33:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-04-07T09:18:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2023-03-22T11:14:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d1f2167-4a10-4778-a2cd-c03c5fa5b463","owner":[],"postedDate":"April 11th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2023-08-18T04:13:10+00:00","versionOfRecord":{"articleIdentity":"rs-2722719","link":"https://doi.org/10.1186/s12877-023-04133-4","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2023-07-13 01:08:21","publishedOnDateReadable":"July 13th, 2023"},"versionCreatedAt":"2023-04-11 18:04:32","video":"","vorDoi":"10.1186/s12877-023-04133-4","vorDoiUrl":"https://doi.org/10.1186/s12877-023-04133-4","workflowStages":[]},"version":"v1","identity":"rs-2722719","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2722719","identity":"rs-2722719","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}