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. Kevin R Wagner
  9. Simon Conroy

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Background and 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 10 September 2020; the search was re-run in Medline up until the 9 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

A total of 2,286 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. In total, 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.

Article activity feed

  1. Version published to 10.1093/ageing/afab008
  2. Version published to 10.1101/2020.11.13.20231365v2 on medRxiv
  3. ScreenIT

    SciScore for 10.1101/2020.11.13.20231365: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategies: Medline, Embase and Web of Science databases were searched with exploded MeSH headings and relevant keywords, restricted to English language.
    Medline
    suggested: (MEDLINE, RRID:SCR_002185)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    MeSH
    suggested: (MeSH, RRID:SCR_004750)
    Databases were searched from inception to 10th September 2020, and references were managed using Endnote software.
    Endnote
    suggested: (EndNote, RRID:SCR_014001)
    coronavirus)) Grey literature was accessed by searching: Open Grey, medRxiv, bioRxiv.
    bioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Implications for research: Larger, more robust studies examining the relationship between COVID-19 and frailty are needed to resolve the limitations of the existing papers. Future studies should preserve the integrity of frailty scales so that comparisons can be made across studies [43], and should take account of the apparent interaction between frailty and COVID-19 testing [20, 33]. Implications for clinical practice: 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 infection. No tool should be used in isolation to direct clinical care, though frailty scores can form part of a more holistic assessment to inform a shared decision making discussion. Frailty can be useful in identifying the risk of complications such as delirium - increasingly being recognised as a high risk scenario [21, 44, 45] – and further frailty or deconditioning [46]. Updated clinical guidance on frailty and COVID, as well as other resources are available here: https://www.criticalcarenice.org.uk/ and the British Geriatrics Society will maintain a live web-repository of COVID and frailty studies [HERE].

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.11.13.20231365v1 on medRxiv