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

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‐...

Descripción completa

Detalles Bibliográficos
Autores principales: Subramaniam, Ashwin, Shekar, Kiran, Afroz, Afsana, Ashwin, Sushma, Billah, Baki, Brown, Hamish, Kundi, Harun, Lim, Zheng Jie, Ponnapa Reddy, Mallikarjuna, Curtis, J. Randall
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons Australia, Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9314619/
https://www.ncbi.nlm.nih.gov/pubmed/35066970
http://dx.doi.org/10.1111/imj.15698
_version_ 1784754360295620608
author Subramaniam, Ashwin
Shekar, Kiran
Afroz, Afsana
Ashwin, Sushma
Billah, Baki
Brown, Hamish
Kundi, Harun
Lim, Zheng Jie
Ponnapa Reddy, Mallikarjuna
Curtis, J. Randall
author_facet Subramaniam, Ashwin
Shekar, Kiran
Afroz, Afsana
Ashwin, Sushma
Billah, Baki
Brown, Hamish
Kundi, Harun
Lim, Zheng Jie
Ponnapa Reddy, Mallikarjuna
Curtis, J. Randall
author_sort Subramaniam, Ashwin
collection PubMed
description 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.
format Online
Article
Text
id pubmed-9314619
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher John Wiley & Sons Australia, Ltd
record_format MEDLINE/PubMed
spelling pubmed-93146192022-07-30 Frailty and mortality associations in patients with COVID‐19: a systematic review and meta‐analysis Subramaniam, Ashwin Shekar, Kiran Afroz, Afsana Ashwin, Sushma Billah, Baki Brown, Hamish Kundi, Harun Lim, Zheng Jie Ponnapa Reddy, Mallikarjuna Curtis, J. Randall Intern Med J Original Articles 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. John Wiley & Sons Australia, Ltd 2022-03-21 2022-05 /pmc/articles/PMC9314619/ /pubmed/35066970 http://dx.doi.org/10.1111/imj.15698 Text en © 2022 Monash University, Peninsula Clinical School. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Subramaniam, Ashwin
Shekar, Kiran
Afroz, Afsana
Ashwin, Sushma
Billah, Baki
Brown, Hamish
Kundi, Harun
Lim, Zheng Jie
Ponnapa Reddy, Mallikarjuna
Curtis, J. Randall
Frailty and mortality associations in patients with COVID‐19: a systematic review and meta‐analysis
title Frailty and mortality associations in patients with COVID‐19: a systematic review and meta‐analysis
title_full Frailty and mortality associations in patients with COVID‐19: a systematic review and meta‐analysis
title_fullStr Frailty and mortality associations in patients with COVID‐19: a systematic review and meta‐analysis
title_full_unstemmed Frailty and mortality associations in patients with COVID‐19: a systematic review and meta‐analysis
title_short Frailty and mortality associations in patients with COVID‐19: a systematic review and meta‐analysis
title_sort frailty and mortality associations in patients with covid‐19: a systematic review and meta‐analysis
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9314619/
https://www.ncbi.nlm.nih.gov/pubmed/35066970
http://dx.doi.org/10.1111/imj.15698
work_keys_str_mv AT subramaniamashwin frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT shekarkiran frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT afrozafsana frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT ashwinsushma frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT billahbaki frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT brownhamish frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT kundiharun frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT limzhengjie frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT ponnapareddymallikarjuna frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis
AT curtisjrandall frailtyandmortalityassociationsinpatientswithcovid19asystematicreviewandmetaanalysis