Abstract: International Journal of Infectious Diseases 102 (2021) 415–421 Contents lists available at ScienceDirect International Journal of Infectious Diseases journal homepage: www.elsevier.com/locate/ijid Risk factors for death in adult COVID-19 patients: Frailty predicts fatal outcome in older patients Sara Tehrania,* , Anna Killandera , Per Åstranda , Jan Jakobssonb , Patrik Gille-Johnsona a Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Division of Internal Medicine and Infectious Diseases, Stockholm, SE18288 Sweden b Karolinska Institutet, Department of Clinical Sciences, Danderyd University Hospital, Division of Intensive Care, Stockholm, Sweden A R T I C L E I N F O A B S T R A C T Article history: Received 26 August 2020 Received in revised form 18 October 2020 Accepted 23 October 2020 Objectives: This study investigated demographics, comorbidities, and death rate in hospitalized patients with confirmed COVID-19. In addition, we hypothesized that functional status, according to the Clinical Frailty Scale (CFS), in patients aged 65 years or older is a better predictor of poor outcome than age and comorbidities. Methods: A total of 255 randomly selected COVID-19 patients admitted to a university hospital were included and followed up for 60 days. Patient data were extracted manually from the electronic health records with use of a standardized protocol. Results: The age of the study population ranged between 20 and 103 years (mean age 66 years  17 years). Hypertension, diabetes mellitus, and obesity were the three most prevalent comorbidities. At the 60-day follow-up, 70 patients (27%) had died. In multivariate analyses, age, chronic kidney disease, and previous stroke were associated with death. Most fatal cases (90%) occurred in patients aged 65 years or older. Among such patients, CFS level was the only predictor of death in multivariate analyses. Conclusions: This study shows that increasing age, chronic kidney disease, and previous stroke significantly contribute to a fatal outcome in hospitalized patients with COVID-19. In patients aged 65 years or older, CFS level was the strongest prognostic factor for death. © 2020 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Keywords: COVID-19 SARS-CoV-2 Risk factors Mortality Clinical Frailty Scale Frailty