What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review

  1. Theodore D. Cosco
  2. John Best
  3. Daniel Davis
  4. Daniele Bryden
  5. Suzanne Arkill
  6. James van Oppen
  7. Indira Riadi
  8. Simon Conroy
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Abstract

Background & aim

The aim of this systematic review was to quantify the association between frailty and COVID-19 in relation to mortality in hospitalised patients.

Methods

Medline, Embase, Web of Science and the grey literature were searched for papers from inception to 10th September 2020; the search was re-run in Medline up until the 9th December 2020. Screening, data extraction and quality grading were undertaken by two reviewers. Results were summarised using descriptive statistics, including a meta-analysis of overall mortality; the relationships between frailty and COVID-19 mortality were summarised narratively.

Results

2286 papers were screened resulting in 26 being included in the review. Most studies were from Europe, half from the UK, and one from Brazil; the median sample size was 242.5, median age 73.1 and 43.5% were female. 22/26 used the Clinical Frailty Scale; reported mortality ranged from 14 to 65%. Most, but not all studies showed an association between increasing frailty and a greater risk of dying. Two studies indicated a sub-additive relationship between frailty, COVID-19 and death, and two studies showed no association.

Conclusions

Whilst the majority of studies have shown a positive association between COVID-19 related death and increasing frailty, some studies suggested a more nuanced understanding of frailty and outcomes in COVID-19 is needed. Clinicians should exert caution in placing too much emphasis on the influence of frailty alone when discussing likely prognosis in older people with COVID-19 illness.

Key points

  • Frailty is being used to assess the risk of dying from COVID-19

  • Emerging studies demonstrate a complex relationship between frailty and COVID-19 related deaths

  • Clinicians should exert caution in placing too much emphasis on the influence of frailty in older people with COVID-19

  • Researchers should ensure that frailty scales are used as designed when planning and reporting future research.

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