Department of Nursing, Chinese Academy of Medical Sciences - Peking Union Medical College, Peking Union Medical College Hospital (Dongdan campus), Beijing, 100730, China.
Shenzhen Second People's Hospital/the First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen, 518000, China.
BMC Geriatr. 2021 Mar 17;21(1):186. doi: 10.1186/s12877-021-02138-5.
A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue.
Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle-Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed.
Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44-59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66-2.38) and 2.48 (95% CI: 1.78-3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68-4.07) and 2.09 (95% CI: 1.40-3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52-5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66-2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81-2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region.
Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.
大量研究探讨了 COVID-19 患者衰弱与死亡率之间的关系，但结果不一致。本荟萃分析旨在综合这方面的证据。
从建库至 2021 年 1 月 20 日，我们检索了 PubMed、Embase 和 Cochrane Library 三个数据库，以寻找相关文献。采用纽卡斯尔-渥太华量表（NOS）评估质量偏倚，采用 STATA 通过随机效应模型汇总效应量。此外，还进行了潜在发表偏倚和敏感性分析。
纳入了 15 项研究，共计 23944 例 COVID-19 患者进行定量分析。总体而言，衰弱的总患病率为 51%（95%CI：44-59%）。与无衰弱的 COVID-19 患者相比，患有衰弱的患者死亡风险增加，合并风险比（HR）和优势比（OR）分别为 1.99（95%CI：1.66-2.38）和 2.48（95%CI：1.78-3.46）。此外，基于人群的亚组分析显示，8 项研究中住院患者和 2 项研究中疗养院居民的合并 OR 分别为 2.62（95%CI：1.68-4.07）和 2.09（95%CI：1.40-3.11）。使用衰弱评估工具的亚组分析表明，使用临床衰弱量表（CFS）进行评估时（纳入 6 项研究，合并 OR=2.88，95%CI：1.52-5.45；纳入 5 项研究，合并 HR=1.99，95%CI：1.66-2.38）和其他衰弱工具（纳入 4 项研究，合并 OR=1.98，95%CI：1.81-2.16）时，这种关联仍然存在。此外，在基于研究设计和地理区域的亚组分析中，这些显著的正相关关系仍然存在。
本研究表明，衰弱是 COVID-19 患者死亡的独立预测因素。因此，衰弱可能是临床医生分层高危人群的预后因素，并提醒医生和护士紧急进行早期筛查和相应干预，以降低感染 SARS-CoV-2 的患者死亡率。
