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Meta-Analysis
. 2021 Mar 17;21(1):186.
doi: 10.1186/s12877-021-02138-5.

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

Xiao-Ming Zhang  1 , Jing Jiao  1 , Jing Cao  1 , Xiao-Peng Huo  1 , Chen Zhu  1 , Xin-Juan Wu  2 , Xiao-Hua Xie  3
Affiliations
Meta-Analysis

Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis

Xiao-Ming Zhang et al. BMC Geriatr. .

Abstract

Background: A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue.

Methods: Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle-Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed.

Results: Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44-59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66-2.38) and 2.48 (95% CI: 1.78-3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68-4.07) and 2.09 (95% CI: 1.40-3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52-5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66-2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81-2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region.

Conclusion: Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.

Keywords: COVID-19; Frailty; Meta-analysis; Mortality; Older adults.

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Conflict of interest statement

The author(s) declare no competing interests.

Figures

Fig. 1
Fig. 1
Research screening flowchart
Fig. 2
Fig. 2
Meta-analysis of the effects of frailty on mortality among patients with COVID-19
Fig. 3
Fig. 3
Meta-analysis of the effects of frailty on mortality based on different settings
Fig. 4
Fig. 4
Meta-analysis of the effects of frailty on mortality based on different frailty assessment scales
See this image and copyright information in PMC

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