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. 2021 May 5;50(3):608-616.
doi: 10.1093/ageing/afab008.

What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review

Theodore D Cosco  1 , John Best  1 , Daniel Davis  2 , Daniele Bryden  3 , Suzanne Arkill  4 , James van Oppen  5 , Indira Riadi  1 , Kevin R Wagner  6 , Simon Conroy  5
Affiliations

What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review

Theodore D Cosco et al. Age Ageing. .

Abstract

Background and aim: The aim of this systematic review was to quantify the association between frailty and COVID-19 in relation to mortality in hospitalised patients.

Methods: Medline, Embase, Web of Science and the grey literature were searched for papers from inception to 10 September 2020; the search was re-run in Medline up until the 9 December 2020. Screening, data extraction and quality grading were undertaken by two reviewers. Results were summarised using descriptive statistics, including a meta-analysis of overall mortality; the relationships between frailty and COVID-19 mortality were summarised narratively.

Results: A total of 2,286 papers were screened resulting in 26 being included in the review. Most studies were from Europe, half from the UK, and one from Brazil; the median sample size was 242.5, median age 73.1 and 43.5% were female. In total, 22/26 used the Clinical Frailty Scale; reported mortality ranged from 14 to 65%. Most, but not all studies showed an association between increasing frailty and a greater risk of dying. Two studies indicated a sub-additive relationship between frailty, COVID-19 and death, and two studies showed no association.

Conclusions: Whilst the majority of studies have shown a positive association between COVID-19-related death and increasing frailty, some studies suggested a more nuanced understanding of frailty and outcomes in COVID-19 is needed. Clinicians should exert caution in placing too much emphasis on the influence of frailty alone when discussing likely prognosis in older people with COVID-19 illness.

Keywords: COVID-19; frailty; hospital-related mortality; older people; systematic review.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Study selection
Figure 2
Figure 2
Random effects meta-analysis showing overall mortality (note high heterogeneity)
See this image and copyright information in PMC

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