Cosco, T;
Best, J;
Bryden, D;
Davis, D;
Wagner, K;
Arkil, S;
Conroy, S;
(2020)
What is the relationship between validated frailty scores and mortality for adults with COVID-19 in acute hospital care? A systematic review.
MedRxiv: Cold Spring Harbor, NY, USA.
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Abstract
Background & aim: The COVID-19 pandemic has had a disproportionate impact upon older people; the frailty construct has been used to assess risk of poor outcomes in many settings. 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 and the grey literature were searched for papers from inception to 10th September 2020. Screening (and grading) was undertaken by two reviewers according to pre-defined inclusion and exclusion criteria. Met-analysis was not possible so the result were summarised narratively. / Results: 2276 papers were screened resulting in 16 being included in the review. All studies were from Europe, mostly the UK; the median sample size was 308.5, mean age of participants 78.7 and 42% were female. 15/16 used the Clinical Frailty Scale; reported mortality ranged from 19 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 one study showed no increase in dying. / Conclusions: This review showed that whilst many studies have shown an association between an increased risk of COVID-19 related death with increasing frailty, other studies demonstrate 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 infection.
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