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

Ashwin Subramaniam; Kiran Shekar; Afsana Afroz; Sushma Ashwin; Baki Billah; Hamish Brown; Harun Kundi; Zheng Jie Lim; Mallikarjuna Ponnapa Reddy; J Randall Curtis

doi:10.1111/imj.15698

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

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

Authors

Ashwin Subramaniam^{1

2

3}, Kiran Shekar^{4

5

6

7}, Afsana Afroz⁸, Sushma Ashwin⁹, Baki Billah³, Hamish Brown¹, Harun Kundi¹⁰, Zheng Jie Lim¹¹, Mallikarjuna Ponnapa Reddy^{1

12}, J Randall Curtis^{13

14}

Affiliations

¹ Department of Intensive Care Medicine, Peninsula Health, Melbourne, Victoria, Australia.
² Peninsula Clinical School, Monash University, Melbourne, Victoria, Australia.
³ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁵ University of Queensland, Brisbane, Queensland, Australia.
⁶ Queensland University of Technology, Brisbane, Queensland, Australia.
⁷ Bond University, Gold Coast, Queensland, Australia.
⁸ Centre for Integrated Critical Care, Department of Medicine and Radiology, Melbourne Medical School, Melbourne, Victoria, Australia.
⁹ Department of Health Economics, School of Health and Social Development, Deakin University, Melbourne, Victoria, Australia.
¹⁰ Department of Cardiology, Ankara City Hospital, Ankara, Turkey.
¹¹ Department of Anaesthesiology, Austin Health, Melbourne, Victoria, Australia.
¹² Department of Intensive Care Medicine, Calvary Hospital, Canberra, Australian Capital Territory, Australia.
¹³ Cambia Palliative Care Centre of Excellence, University of Washington, Seattle, Washington, USA.
¹⁴ Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA.

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.

Publication types

Meta-Analysis
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Aged
COVID-19*
Frail Elderly
Frailty* / diagnosis
Frailty* / epidemiology
Hospital Mortality
Humans
Intensive Care Units
Length of Stay
Male
Pandemics