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Meta-Analysis
. 2022 May;52(5):724-739.
doi: 10.1111/imj.15698. Epub 2022 Mar 21.

Frailty and mortality associations in patients with COVID-19: a systematic review and meta-analysis

Ashwin Subramaniam  1   2   3 , Kiran Shekar  4   5   6   7 , Afsana Afroz  8 , Sushma Ashwin  9 , Baki Billah  3 , Hamish Brown  1 , Harun Kundi  10 , Zheng Jie Lim  11 , Mallikarjuna Ponnapa Reddy  1   12 , J Randall Curtis  13   14
Affiliations
Meta-Analysis

Frailty and mortality associations in patients with COVID-19: a systematic review and meta-analysis

Ashwin Subramaniam et al. Intern Med J. 2022 May.

Abstract

Background: Observational data during the pandemic have demonstrated mixed associations between frailty and mortality.

Aim: To examine associations between frailty and short-term mortality in patients hospitalised with coronavirus disease 2019 (COVID-19).

Methods: In this systematic review and meta-analysis, we searched PubMed, Embase and the COVID-19 living systematic review from 1 December 2019 to 15 July 2021. Studies reporting mortality and frailty scores in hospitalised patients with COVID-19 (age ≥18 years) were included. Data on patient demographics, short-term mortality (in hospital or within 30 days), intensive care unit (ICU) admission and need for invasive mechanical ventilation (IMV) were extracted. The quality of studies was assessed using the Newcastle-Ottawa Scale.

Results: Twenty-five studies reporting 34 628 patients were included. Overall, 26.2% (n = 9061) died. Patients who died were older (76.7 ± 9.6 vs 69.2 ± 13.4), more likely male (risk ratio (RR) = 1.08; 95% confidence interval (CI): 1.06-1.11) and had more comorbidities. Fifty-eight percent of patients were frail. Adjusting for age, there was no difference in short-term mortality between frail and non-frail patients (RR = 1.04; 95% CI: 0.84-1.28). The non-frail patients were commonly admitted to ICU (27.2% (4256/15639) vs 29.1% (3567/12274); P = 0.011) and had a higher mortality risk (RR = 1.63; 95% CI: 1.30-2.03) than frail patients. Among patients receiving IMV, there was no difference in mortality between frail and non-frail (RR = 1.62; 95% CI 0.93-2.77).

Conclusion: This systematic review did not demonstrate an independent association between frailty status and short-term mortality in patients with COVID-19. Patients with frailty were less commonly admitted to ICU and non-frail patients were more likely to receive IMV and had higher mortality risk. This finding may be related to allocation decisions for patients with frailty amidst the pandemic.

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

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Figures

Figure 1
Figure 1
Non‐survivors among frail and non‐frail patients. (A) All studies and (B) age stratified.
Figure 2
Figure 2
Intensive care unit therapy among survivors and non‐survivors. (A) Age group for patients admitted to intensive care unit (ICU); (B) ICU admissions among frail and non‐frail patients; (C) patients who required invasive mechanical ventilation (IMV); and (D) invasive mechanical ventilation (IMV) among frail and non‐frail patients.
Figure 3
Figure 3
Sensitivity analysis using only clinical frailty scale (CFS): risk associated with increased frailty: CFS 1–3 (reference) with increasing CFS scores.
See this image and copyright information in PMC

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