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Meta-Analysis
. 2021 Mar-Apr:93:104324.
doi: 10.1016/j.archger.2020.104324. Epub 2020 Dec 15.

Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis

Raymond Pranata  1 , Joshua Henrina  2 , Michael Anthonius Lim  3 , Sherly Lawrensia  4 , Emir Yonas  5 , Rachel Vania  6 , Ian Huang  7 , Antonia Anna Lukito  8 , Ketut Suastika  9 , R A Tuty Kuswardhani  10 , Siti Setiati  11
Affiliations
Meta-Analysis

Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis

Raymond Pranata et al. Arch Gerontol Geriatr. 2021 Mar-Apr.

Abstract

Introduction: National Institute for Health and Care Excellence (NICE) endorsed clinical frailty scale (CFS) to help with decision-making. However, this recommendation lacks an evidence basis and is controversial. This meta-analysis aims to quantify the dose-response relationship between CFS and mortality in COVID-19 patients, with a goal of supplementing the evidence of its use.

Methods: We performed a systematic literature search from several electronic databases up until 8 September 2020. We searched for studies investigating COVID-19 patients and reported both (1) CFS and its distribution (2) CFS and its association with mortality. The outcome of interest was mortality, defined as clinically validated death or non-survivor. The odds ratio (ORs) will be reported per 1% increase in CFS. The potential for a non-linear relationship based on ORs of each quantitative CFS was examined using restricted cubic splines with a three-knots model.

Results: There were a total of 3817 patients from seven studies. Mean age was 80.3 (SD 8.2), and 53% (48-58%) were males. The pooled prevalence for CFS 1-3 was 34% (32-36%), CFS 4-6 was 42% (40-45%), and CFS 7-9 was 23% (21-25%). Each 1-point increase in CFS was associated with 12% increase in mortality (OR 1.12 (1.04, 1.20), p = 0.003; I2: 77.3%). The dose-response relationship was linear (Pnon-linearity=0.116). The funnel-plot analysis was asymmetrical; Trim-and-fill analysis by the imputation of two studies on the left side resulted in OR of 1.10 [1.03, 1.19].

Conclusion: This meta-analysis showed that increase in CFS was associated with increase in mortality in a linear fashion.

Keywords: Age; COVID-19; Coronavirus; Frailty; Prognosis; Risk stratification.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Clinical Frailty Scale and Mortality in COVID-19. The odds ratio is for per one-point increment in the scale.
Fig. 3
Fig. 3
Dose response meta-analysis between clinical frailty scale and mortality with restricted cubic splines in a random-effects dose-response model. Solid line indicates odds ratio and long dashed lines indicate its 95% confidence interval.
Fig. 4
Fig. 4
Funnel plot analysis (A) and trim-and-fill analysis (B).
Fig. 4
Fig. 4
Funnel plot analysis (A) and trim-and-fill analysis (B).
See this image and copyright information in PMC

Comment in

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