Clinical Frailty Is Associated With Increased In-Hospital, Mortality in Patients With COVID-19

September 8, 2021

By Nancy Melville

BRUSSELS -- September 7, 2021 -- Patients with coronavirus disease 2019 (COVID-19) who have high scores indicating clinical frailty show significantly higher rates of in-hospital and 30-day mortality, according to a study presented at the 40th International Symposium on Intensive Care and Emergency Medicine.

“To the best of our knowledge, this is the largest, most recent and comprehensive meta-analysis of studies on this topic today in patients with COVID-19,” said Mate Rottler, MD, Fejér County Szent György University Teaching Hospital, Székesfehérvár, Hungary. “Regarding implications for practice, we believe that frailty-based patient management should be included in international COVID-19 treatment guidelines.”

The researchers identified 27 studies in a qualitative analysis and 21 studies in a quantitative analysis Of the studies, 24 used the Clinical Frailty Scale (CFS). Collectively, the studies showed that frail patients, with a CFS of 5 to 9, compared with patients with a score of 1 to 4 -- showing no frailty -- had a higher risk for in-hospital mortality (odds ratio [OR] = 2.77; 95% confidence interval [CI], 1.86-4.15), and a higher risk of 30-day mortality (OR = 1.47; 95% CI, 1.05- 2.06). The overall risk of mortality was also higher among frail patients (OR = 2.22; 95% CI, 1.64-3.01).

Non-survivors’ average CFS scores were also significantly higher than survivors’ scores, with an overall weighted mean difference (WMD) of 1.14 (95% CI, 0.70-1.58).

The authors noted significant heterogeneity among those with CFS scores of 1 to 4 and 5 to 9.
A quantitative analysis for the length of hospitalisation was not feasible.

“Our results show that frailty as determined by CFS is strongly associated with in-hospital and 30-day mortality and may also play an important role in determining eligibility for intensive care unit admission in patients with COVID-19,” said Dr. Rottler. “These findings have implications for research -- they render the need for further comparisons of different frailty scores in patients with COVID-19 in order to determine the most appropriate [approach].”
[Presentation 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. Abstract A97]