BACKGROUND: Data regarding the importance of multidimensional frailty to guide clinical decision making for remdesivir use in older patients with coronavirus disease 2019 (COVID-19) are largely unexplored. OBJECTIVE: The aim of this research was to evaluate if the Multidimensional Prognostic Index (MPI), a multidimensional frailty tool based on the Comprehensive Geriatric Assessment (CGA), may help physicians in identifying older hospitalized patients affected by COVID-19 who might benefit from the use of remdesivir. METHODS: This was a multicenter, prospective study of older adults hospitalized for COVID-19 in 10 European hospitals, followed-up for 90 days after hospital discharge. A standardized CGA was performed at hospital admission and the MPI was calculated, with a final score ranging between 0 (lowest mortality risk) and 1 (highest mortality risk). We assessed survival with Cox regression, and the impact of remdesivir on mortality (overall and in hospital) with propensity score analysis, stratified by MPI = 0.50. RESULTS: Among 496 older adults hospitalized for COVID-19 (mean age 80 years, female 59.9%), 140 (28.2% of patients) were treated with remdesivir. During the 90 days of follow-up, 175 deaths were reported, 115 in hospital. Remdesivir treatment significantly reduced the risk of overall mortality (hazard ratio [HR] 0.54, 95% confidence interval CI 0.35-0.83 in the propensity score analysis) in the sample as whole. Stratifying the population, based on MPI score, the effect was observed only in less frail participants (HR 0.47, 95% CI 0.22-0.96 in propensity score analysis), but not in frailer subjects. In-hospital mortality was not influenced by remdesivir use. CONCLUSIONS: MPI could help to identify less frail older adults hospitalized for COVID-19 who could benefit more from remdesivir treatment in terms of long-term survival.

Ageing Clinical Research Department 2 of Internal Medicine and Center for Molecular Medicine University of Cologne Cologne Germany

Department of Geriatric Care Orthogeriatrics and Rehabilitation Galliera Hospital Genoa Italy

Department of Geriatrics 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Interdisciplinary Medicine University of Bari Aldo Moro Bari Italy

Division of Geriatrics University Medical Center Goettingen Goettingen Germany

Faculty of Health and Social Sciences University of South Bohemia Ceske Budejovice Czech Republic

Geriatric Unit Department of Internal Medicine and Geriatrics University of Palermo via del Vespro 141 90127 Palermo Italy

Geriatrics Unit Mater Salutis Hospital Legnago ULSS 9 Scaligera Verona Italy

Geriatrics Unit Pugliese Ciaccio Hospital Catanzaro Italy

Infectious Disease Unit Sanremo Hospital ASL 1 Imperiese Sanremo Italy

Klinikum Oldenburg AöR Oldenburg University Oldenburg Germany

Neurology Unit Department of Clinical and Experimental Sciences University of Brescia Brescia Italy

Servicio de Geriatría Hospital Universitario Ramón y Cajal Madrid Spain

Serviço de Medicina Interna Hospital Curry Cabral Centro Hospitalar Universitário Lisboa Central Universidade Nova de Lisboa Lisbon Portugal

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