• Michele Fiorentino, Sri Ram Pentakota, Anne C Mosenthal, and Nina E Glass.
• Rutgers New Jersey Medical School, Newark, NJ, USA.
• Palliat Med. 2020 Oct 1; 34 (9): 1228-1234.

BackgroundCoronavirus disease 2019 (COVID-19) has a substantial mortality risk with increased rates in the elderly. We hypothesized that age is not sufficient, and that frailty measured by preadmission Palliative Performance Scale would be a predictor of outcomes. Improved ability to identify high-risk patients will improve clinicians' ability to provide appropriate palliative care, including engaging in shared decision-making about life-sustaining therapies.AimTo evaluate whether preadmission Palliative Performance Scale predicts mortality in hospitalized patients with COVID-19.DesignRetrospective observational cohort study of patients admitted with COVID-19. Palliative Performance Scale was calculated from the chart. Using logistic regression, Palliative Performance Scale was assessed as a predictor of mortality controlling for demographics, comorbidities, palliative care measures and socioeconomic status.Setting/ParticipantsPatients older than 18 years of age admitted with COVID-19 to a single urban public hospital in New Jersey, USA.ResultsOf 443 admitted patients, we determined the Palliative Performance Scale score for 374. Overall mortality was 31% and 81% in intubated patients. In all, 36% (134) of patients had a low Palliative Performance Scale score. Compared with patients with a high score, patients with a low score were more likely to die, have do not intubate orders and be discharged to a facility. Palliative Performance Scale independently predicts mortality (odds ratio 2.89; 95% confidence interval 1.42-5.85).ConclusionsPreadmission Palliative Performance Scale independently predicts mortality in patients hospitalized with COVID-19. Improved predictors of mortality can help clinicians caring for patients with COVID-19 to discuss prognosis and provide appropriate palliative care including decisions about life-sustaining therapy.

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