The Impact of Frailty on COVID-19 Outcomes: A Systematic Review and Meta-analysis of 16 Cohort Studies

Abstract

Background: Frail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. Objective: We aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice. Design: A systematic review and Meta-analysis of 16 cohort studies. Participants: Patients with COVID-19. Methods: A systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects. Results: According to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay. Conclusions: In this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all-cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.

Association of frailty with outcomes in individuals with COVID‐19: A living review and meta‐analysis

“…There have been several other reviews exploring the relationship between frailty and health outcomes for individuals with COVID‐19 75–78 . However, the current review is, to our knowledge, the only living review, most up to date, largest and addresses the widest breadth of outcomes (informed by a widely used health outcome framework, the IHI Triple Aim).…”

The Effect of the Vitamin D Level on the Clinical, Laboratory, and Outcome in Patients Over 65 Years of Age With Covid-19: Comprehensive Tertiary Center Experience

“…There was consolidation, a ground glass appearance, and bilateral involvement on thoracic CT images in 27.7% (36), 35.3% (46), and 36.9% (48) of the patients, re- spectively. The median psoas muscle CSA was 2.09 cm 2 (1.55-3.06), the median PMI was 0.09 cm 2 /kg/ m 2 (0.07-0.12), and the median psoas density was 49.9 (44.6-53.7) on CT images acquired at the time of initial hospital admission. The demographic, clinical, laboratory, and radiological findings of the participants are presented in Tables 1 and 2.…”

“…Previous studies have found advanced age, male gender, high Sequential Organ Failure Assessment Scores, and high D-dimer levels and comorbidities to be associated with poor prognosis in COVID-19 patients (3,4). In addition, a recent meta-analysis found that frailty increases the severity, morbidity, and mortality risk associated with COVID-19 (2). Several guidelines, such as the National Institute for Health and Care Excellence guidelines, can be recommended for the assessment of frailty in COV-ID-19 patients over the age of 65 years (5).…”

“…During pandemics, limited access to healthcare resources requires appropriate triage, and for both appropriate triage and successful patient management, prognostic factors should be well known (2). Previous studies have found advanced age, male gender, high Sequential Organ Failure Assessment Scores, and high D-dimer levels and comorbidities to be associated with poor prognosis in COVID-19 patients (3,4).…”

Journal of Nutrition, Health & Aging: Summary of Recent Work and Future Directions

“…Under the capable direction of Professor Morley, the journal has striven to gain a better understanding of the clinical implications of the COVID-19 pandemic for older adults. Over 60 Journal's publications, many featuring renowned geriatrics experts, have proposed insightful perspectives and practical solutions to combat the burdens associated with the pandemic, such as social isolation and containment (7)(8)(9)(10)(11)(12).…”