Frailty worsens mortality risk in COVID-19

The risk of death from the novel coronavirus disease (COVID-19) seems to be higher among elderly frail patients, a recent study has found.

“Frailty assessment may help to guide prognosis and individualized care planning, but data relating frailty status to patient-reported outcomes are urgently needed to provide a more comprehensive overview of outcomes relevant to older adults,” the researchers said.

Drawing from Google Scholar and Google Web Search, they retrieved 52 studies that investigated the associations between COVID-19 outcomes and frailty. The cumulative sample included 118,373 patients, in whom the primary outcome of mortality was assessed. Secondary outcomes included delirium, intensive care admission, and need for ventilation.

Thirty-seven studies reported mortality as an outcome. Pooled analysis including only those with confounder adjustment showed that frailty nearly doubled the risk of death in COVID-19 patients (adjusted odds ratio [OR], 1.79, 95 percent confidence interval [CI], 1.49–2.14). Hazard ratio (HR) analysis yielded a similar estimate (adjusted HR, 1.87, 95 percent CI, 1.33–2.61).

Similarly, frailty correlated with the likelihood of delirium (OR, 2.91, 95 percent CI, 2.00–4.25), intensive care admissions (OR, 0.24, 95 percent CI, 0.08–0.71), and mechanical ventilation (OR, 0.31, 95 percent CI, 0.08–1.30). None of the analyses for secondary outcomes were adjusted for confounders.

In terms of quality, only 10 of the included studies had low risk of bias; 27 and 15 had moderate, or high or unclear risks of bias, respectively. Main contributors to bias were issues regarding confounding, reporting, and statistical analysis.