Frailty and mortality associations in patients with COVID-19: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review of non-randomized observational cohort studies
PubMed 35066970 · doi:10.1111/imj.15698
What was done
A systematic review and meta-analysis searched PubMed, Embase, and the COVID-19 living systematic review from December 1, 2019, to July 15, 2021. The authors included studies reporting frailty scores and short-term mortality (in-hospital or within 30 days), intensive care unit (ICU) admission, and invasive mechanical ventilation (IMV) in hospitalized COVID-19 patients aged 18 years or older. Study quality was evaluated using the Newcastle-Ottawa Scale.
What was found
Twenty-five studies covering 34,628 patients were included; 58% of patients were frail, and overall mortality was 26.2% (n = 9,061). Decedents were older (76.7 ± 9.6 vs 69.2 ± 13.4 years), more frequently male (RR = 1.08; 95% CI: 1.06-1.11), and had more comorbidities. After adjusting for age, short-term mortality did not differ between frail and non-frail patients (RR = 1.04; 95% CI: 0.84-1.28). Non-frail patients were more frequently admitted to the ICU (27.2% vs 29.1%; P = 0.011) and had a higher mortality risk than frail patients (RR = 1.63; 95% CI: 1.30-2.03). Among patients receiving IMV, mortality was not significantly different between frail and non-frail cohorts (RR = 1.62; 95% CI: 0.93-2.77).
Why it matters
This review shows that frailty status was not independently associated with short-term COVID-19 mortality after controlling for age. It highlights that differences in ICU admission and invasive intervention patterns during the pandemic may have substantially confounded observed outcomes between frail and non-frail groups.
Limits
All included studies were observational. Variations in frailty assessment tools across studies were present, and clinical triage policies, treatment escalation ceilings, and advance care directives were not standardized or fully controlled for across cohorts.
Cited by
- context During the COVID-19 pandemic, frailty was associated with a higher risk of mortality than obesity.