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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2022

Open Access 01-12-2022 | Care | Research

Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis

Authors: Máté Rottler, Klementina Ocskay, Zoltán Sipos, Anikó Görbe, Marcell Virág, Péter Hegyi, Tihamér Molnár, Bálint Erőss, Tamás Leiner, Zsolt Molnár

Published in: Annals of Intensive Care | Issue 1/2022

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Abstract

Background

The concept of frailty provides an age-independent, easy-to-use tool for risk stratification. We aimed to summarize the evidence on the efficacy of frailty tools in risk assessment in COVID-19 patients.

Methods

The protocol was registered (CRD42021241544). Studies reporting on frailty in COVID-19 patients were eligible. The main outcomes were mortality, length of hospital stay (LOH) and intensive care unit (ICU) admission in frail and non-frail COVID-19 patients. Frailty was also compared in survivors and non-survivors. Five databases were searched up to 24th September 2021. The QUIPS tool was used for the risk of bias assessment. Odds ratios (OR) and weighted mean differences (WMD) were calculated with 95% confidence intervals (CI) using a random effect model. Heterogeneity was assessed using the I2 and χ2 tests.

Results

From 3640 records identified, 54 were included in the qualitative and 42 in the quantitative synthesis. Clinical Frailty Scale (CFS) was used in 46 studies, the Hospital Frailty Risk Score (HFRS) by 4, the Multidimensional Prognostic Index (MPI) by 3 and three studies used other scores. We found that patients with frailty (CFS 4–9 or HFRS ≥ 5) have a higher risk of mortality (CFS: OR: 3.12; CI 2.56–3.81; HFRS OR: 1.98; CI 1.89–2.07). Patients with frailty (CFS 4–9) were less likely to be admitted to ICU (OR 0.28, CI 0.12–0.64). Quantitative synthesis for LOH was not feasible. Most studies carried a high risk of bias.

Conclusions

As determined by CFS, frailty is strongly associated with mortality; hence, frailty-based patient management should be included in international COVID-19 treatment guidelines. Future studies investigating the role of frailty assessment on deciding ICU admission are strongly warranted.
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Metadata
Title
Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis
Authors
Máté Rottler
Klementina Ocskay
Zoltán Sipos
Anikó Görbe
Marcell Virág
Péter Hegyi
Tihamér Molnár
Bálint Erőss
Tamás Leiner
Zsolt Molnár
Publication date
01-12-2022
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2022
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-021-00977-4

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