Characteristics and Outcomes of Patients With Frailty Admitted to ICU With Coronavirus Disease 2019: An Individual Patient Data Meta-Analysis

Abstract

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Association of Frailty, Organ Support, and Long-Term Survival in Critically Ill Patients With COVID-19

“…Furthermore, end-of-life practices during critical illness vary worldwide, and in Latin America, such care restrictions often take longer to implement and occur when the patient is near death ( 25 ). This practice might differ from what is commonly reported in Europe and North America in the pre-COVID-19 period ( 25 ) and might explain our distinct findings from previous reports ( 2 , 3 ).…”

“…Since the CFS is a feasible and well-known frailty tool in critical care ( 2 , 22 , 23 ), our results encourage its incorporation into the ICU practice. It is also worth mentioning that differently from previous studies ( 3 , 23 ), we determined the prognostic effect of frailty on 6-month mortality, incorporating aspects related to long-COVID complications. Exploring long-term survival is relevant as recent work has indicated that frailty increases the risk of patient-centered adverse outcomes (e.g., functional disability) in COVID-19 ICU survivors after hospital discharge ( 11 ).…”

“…A recent international multicenter COVID-19 cohort of older ICU patients reported that frailty was independently associated with a higher rate of treatment limitations, notably a lesser use of invasive mechanical ventilation ( 2 ). In fact, during the first wave of the pandemics (when most of the publications were performed, as recently reviewed in an individual patient data meta-analysis [ 3 ]), frail patients were less likely to receive mechanical ventilation ( 3 ). These studies contrast with our observation of similar rate of invasive organ support across levels of frailty.…”

“…Additionally, data from developing countries and younger patients are underrepresented in the context of patients admitted to the ICU with COVID-19 (2). Furthermore, the association between frailty and ICU resource use is discordant between recent reports (2,3,6,7). Finally, while the Clinical Frailty Scale (CFS) is the most commonly used frailty tool in acute care, its accuracy compared with other validated multidimensional frailty measures remains uncertain in the ICU context (8).…”

“…Frail patients are more vulnerable to adverse outcomes (e.g., mortality, disability), particularly in critical illness ( 1 ). Recently, frailty has been proposed as a significant risk factor for short-term mortality in critically ill patients with the COVID-19 ( 1 – 3 ).…”