Frailty as a predictor of mortality among patients with COVID-19: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational cohort studies
PubMed 33731018 · doi:10.1186/s12877-021-02138-5
What was done
Authors searched PubMed, Embase, and Cochrane Library through January 20, 2021, for studies evaluating the link between frailty and mortality in COVID-19 patients. Quality was evaluated using the Newcastle-Ottawa Scale. Effect sizes were pooled using random-effects meta-analysis in STATA, alongside sensitivity, subgroup, and publication bias analyses. A total of 15 studies with 23,944 COVID-19 patients were analyzed.
What was found
The pooled prevalence of frailty was 51% (95% CI: 44% to 59%). Frail COVID-19 patients had significantly higher mortality than non-frail patients (pooled HR = 1.99, 95% CI: 1.66 to 2.38; pooled OR = 2.48, 95% CI: 1.78 to 3.46). Subgroup analysis showed an elevated mortality risk in hospitalized patients (8 studies, pooled OR = 2.62, 95% CI: 1.68 to 4.07) and nursing home residents (2 studies, pooled OR = 2.09, 95% CI: 1.40 to 3.11). Risk remained consistent when evaluated using the Clinical Frailty Scale (6 studies, pooled OR = 2.88, 95% CI: 1.52 to 5.45; 5 studies, pooled HR = 1.99, 95% CI: 1.66 to 2.38) or other tools (4 studies, pooled OR = 1.98, 95% CI: 1.81 to 2.16).
Why it matters
This review demonstrates that frailty roughly doubles the risk of death from COVID-19, supporting the use of routine frailty assessments to stratify risk in hospital and residential care settings.
Limits
The analysis relies entirely on observational studies, which carry inherent risks of confounding from comorbidities and age. Heterogeneity in frailty measurement tools existed across the included cohorts. Data for nursing home residents were restricted to only two studies, and the abstract does not report whether analyses accounted for variations in acute medical care, triage policies, or treatment regimens.
Cited by
- supports During the COVID-19 pandemic, frailty was associated with a higher risk of mortality than obesity.