Association of frailty index of laboratory tests (FI-LAB) and COVID-19 clinical outcomes in veterans with cancer

e24023 Background: Veterans with cancer have high COVID-19-attributable mortality. Frailty, a multisystem syndrome characterized by vulnerability to stressors from loss of physiological reserve, is common in cancer patients and confers worse clinical outcomes. In hospitalized cancer patients with COVID-19 infection, the role of frailty remains unclear. Our study aim was to compare clinical and utilization outcomes of cancer patients hospitalized with COVID-19 according to frailty status. Methods: The retrospective cohort study included hospitalized veterans with cancer and acute COVID-19 infection at 7 VA facilities in Florida and Puerto Rico from March-August 2020. Frailty was assessed using a 31-item frailty index of laboratory tests and vital signs (FI-LAB) with scores grouped by tertiles. We chart reviewed VA databases to collect Veterans’ socio-demographics, COVID-19 Polymerase Chain Reaction (PCR) results, and clinical and utilization outcomes. We ran binomial logistic regression analyses to calculate the odds of inpatient death, ICU admission, ICU transfer, prolonged length of stay, new nursing home placement, 30-day readmission, 30-day mortality, 6-month,1-year, and 2-year mortality according to the tertiles, adjusted for age, BMI, sex, race, ethnicity, and other conditions with greater risk for poor COVID-19 outcomes. Patients were followed until death or August 13, 2022. Results: 143 older Veterans with cancer were hospitalized with a mean age of 74.4 years (SD = 11.5) years, 95.9% (n = 117) male, 66.4% white (n = 81), and 9.8% (n = 12) Hispanic. 122 (85.3%) met the inclusion criteria. There were no differences in baseline sociodemographic or clinical characteristics except for a higher prevalence of congestive heart failure. The upper FI-LAB tertile had a higher risk of inpatient death, OR 12.47 (95%CI:1.3-121.4), p = 0.03, 30-day post-discharge mortality, OR 9.78 (95%CI:.21-79.4), p = .03 and 2-yr post-discharge mortality OR 4.9 (1.2-19.6) p < 0.03. There were no differences in other clinical and utilization outcomes. Conclusions: In hospitalized Veterans with cancer and coexistent COVID-19 infection, patients with higher levels of frailty have a greater risk of inpatient death, 30-day post-discharge mortality, and 2-year post-discharge mortality. More studies are needed to confirm the utility of FI-LAB in hospitalized patients with COVID-19 and cancer.