Nanhai Liu, Department of neurology, the first affiliated hospital of Gannan medical university,Ganzhou, Jiangxi province, China. Email:
J Nutr Health Aging. 2021;25(5):702-709. doi: 10.1007/s12603-021-1611-9.
Frail patients are increasingly vulnerable to stress, which is mainly manifested by a reduced physiologic reserve in metabolic and immune systems and neuromuscular system. Several studies found a significant association of frailty with COVID-19 severity to support the evidence for the application of frailty assessment. However, there were contradictory results in other studies. Thus we conducted a systematic review and meta-analysis to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice.
We aimed to synthesize the current studies to investigate impact of frailty on COVID-19 outcomes and provide evidence-based decisions in clinical practice.
A systematic review and Meta-analysis of 16 cohort studies.
Patients with COVID-19.
A systematic retrieving for potential literature was conducted in several public electronic databases, including Medline(OvidSP), EMBASE, Pubmed and Chinese databases(China National Knowledge Infrastructure,Wanfang and Weipu) on August 1, 2020.The literature research was updated on October 26, 2020. Newcastle Ottawa Scale for cohort studies was used for quality assessment. RevMan (Version 5.3) and Stata 14.0 were used to synthesize the pooled effects.
According to the predefined inclusion and exclusion criteria, sixteen studies of 4324 patients were included in the final analysis. Frailty was significantly associated with increased risk of all-cause mortality among patients with COVID-19, with pooled adjusted odds ratios of 1.81 (95% confidence intervals:1.48,2.21, I2=87.0%, P<0.001). The result was consistent in stratified analysis to according to age, patient source, definitions of frailty, study quality, and adjustment method. Frailty was significant associated with an increased risk of COVID-19 severity, admission to intensive care unit, application of invasive mechanical ventilation, long-length stay.
In this meta-analysis, we found frailty was significantly associated with an increased risk of clinical adverse events (all- cause mortality, COVID-19 severity, admission to the intensive care unit, application of invasive mechanical ventilation, long-length stay). Given the epidemic of COVID-19 and shortage of medical resources, paying more attention to screening frailty would contribute to disease management and resource allocation among patients with COVID-19.
衰弱患者更容易受到压力的影响，这种压力主要表现为代谢和免疫系统以及神经肌肉系统的生理储备减少。一些研究发现衰弱与 COVID-19 严重程度之间存在显著关联，这为应用衰弱评估提供了证据。然而，其他研究的结果却存在矛盾。因此，我们进行了系统综述和荟萃分析，以综合目前的研究结果，探讨衰弱对 COVID-19 结局的影响，并为临床实践提供循证决策。
综合目前的研究结果，探讨衰弱对 COVID-19 结局的影响，并为临床实践提供循证决策。
对 16 项队列研究进行系统综述和荟萃分析。
COVID-19 患者。
于 2020 年 8 月 1 日在多个公共电子数据库（包括 Medline（OvidSP）、EMBASE、PubMed 和中国数据库（中国国家知识基础设施、万方和维普））中进行了潜在文献的系统检索。2020 年 10 月 26 日对文献检索进行了更新。采用纽卡斯尔-渥太华量表对队列研究进行质量评估。采用 RevMan（版本 5.3）和 Stata 14.0 对汇总效应进行合并。
根据预先确定的纳入和排除标准，最终有 16 项研究的 4324 名患者纳入最终分析。衰弱与 COVID-19 患者全因死亡率增加显著相关，合并调整后的比值比为 1.81（95%置信区间：1.48，2.21，I2=87.0%，P<0.001）。根据年龄、患者来源、衰弱定义、研究质量和调整方法进行分层分析，结果一致。衰弱与 COVID-19 严重程度、入住重症监护病房、应用有创机械通气、住院时间延长显著相关。
在这项荟萃分析中，我们发现衰弱与临床不良事件（全因死亡率、COVID-19 严重程度、入住重症监护病房、应用有创机械通气、住院时间延长）的风险增加显著相关。鉴于 COVID-19 的流行和医疗资源的短缺，更多地关注衰弱的筛查将有助于 COVID-19 患者的疾病管理和资源分配。
