Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
Siloam Heart Institute, Jakarta, Indonesia.
Arch Gerontol Geriatr. 2021 Mar-Apr;93:104324. doi: 10.1016/j.archger.2020.104324. Epub 2020 Dec 15.
National Institute for Health and Care Excellence (NICE) endorsed clinical frailty scale (CFS) to help with decision-making. However, this recommendation lacks an evidence basis and is controversial. This meta-analysis aims to quantify the dose-response relationship between CFS and mortality in COVID-19 patients, with a goal of supplementing the evidence of its use.
We performed a systematic literature search from several electronic databases up until 8 September 2020. We searched for studies investigating COVID-19 patients and reported both (1) CFS and its distribution (2) CFS and its association with mortality. The outcome of interest was mortality, defined as clinically validated death or non-survivor. The odds ratio (ORs) will be reported per 1% increase in CFS. The potential for a non-linear relationship based on ORs of each quantitative CFS was examined using restricted cubic splines with a three-knots model.
There were a total of 3817 patients from seven studies. Mean age was 80.3 (SD 8.2), and 53% (48-58%) were males. The pooled prevalence for CFS 1-3 was 34% (32-36%), CFS 4-6 was 42% (40-45%), and CFS 7-9 was 23% (21-25%). Each 1-point increase in CFS was associated with 12% increase in mortality (OR 1.12 (1.04, 1.20), p = 0.003; I: 77.3%). The dose-response relationship was linear (P=0.116). The funnel-plot analysis was asymmetrical; Trim-and-fill analysis by the imputation of two studies on the left side resulted in OR of 1.10 [1.03, 1.19].
This meta-analysis showed that increase in CFS was associated with increase in mortality in a linear fashion.
英国国家卫生与保健优化研究所（NICE）认可了临床虚弱量表（CFS），以帮助临床决策。然而，这一推荐缺乏证据基础，存在争议。本荟萃分析旨在量化 CFS 与 COVID-19 患者死亡率之间的剂量-反应关系，以补充其使用证据。
我们从多个电子数据库进行了系统文献检索，检索截至 2020 年 9 月 8 日。我们检索了调查 COVID-19 患者的研究，并报告了以下内容：（1）CFS 及其分布；（2）CFS 与其死亡率的关系。感兴趣的结局是死亡率，定义为临床验证的死亡或非幸存者。报告的结果为每增加 1% CFS 的比值比（OR）。使用具有三个结的三次样条限制立方样条来检查基于每个定量 CFS 的 OR 是否存在非线性关系。
共有来自 7 项研究的 3817 名患者。平均年龄为 80.3（8.2）岁，53%（48-58%）为男性。CFS 1-3 的总患病率为 34%（32-36%），CFS 4-6 的患病率为 42%（40-45%），CFS 7-9 的患病率为 23%（21-25%）。CFS 每增加 1 分，死亡率增加 12%（OR 1.12（1.04，1.20），p=0.003；I：77.3%）。剂量-反应关系呈线性（P=0.116）。漏斗图分析显示不对称；通过在左侧填补两项研究，Trim-and-fill 分析得出的 OR 为 1.10[1.03，1.19]。
本荟萃分析表明，CFS 增加与死亡率呈线性增加相关。
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