Kastora Stavroula, Kounidas Georgios, Perrott Sarah, Carter Ben, Hewitt Jonathan, Myint Phyo Kyaw
Medical Sciences & Nutrition, University of Aberdeen School of Medicine, Aberdeen, United Kingdom.
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
EClinicalMedicine. 2021 May 23;36:100896. doi: 10.1016/j.eclinm.2021.100896. eCollection 2021 Jun.
COVID-19 has resulted in the largest pandemic experienced since 1918, accounting for over 2 million deaths globally. Frail and older people are at the highest risk of mortality. The main objective of the present research was to quantify the impact of clinical frailty scale (CFS) by increasing severity of frailty and to identify other personal prognostic factors associated with increased mortality from COVID-19.
This study offers a contemporary systematic review and meta-analysis to analyse the stratified mortality risk by increasing CFS sub-categories (1-3, 4-5 and 6-9). Databases searched included EMBASE, MEDLINE, CAB Abstracts, PsychInfo, and Web of Science with end-search restriction the 18th December 2020. Publications identified via MedRevix were followed up on the 23rd March 2021 in peer-reviewed database search, and citations were updated as published. Prospective and retrospective cohort studies which reported the association between CFS and COVID-19 mortality were included. Thirty-four studies were eligible for systematic review and seventeen for meta-analysis, with 81-87% (I) heterogeneity.
All studies [N: 34] included patients from a hospital setting, comprising a total of 18,042 patients with mean age 72.8 (Min: 56; Max: 86). The CFS 4-5 patient group had significantly increased mortality when compared to patients with CFS 1-3 [(RE) OR 1.95 (1.32 (95% CI), 2.87 (95% CI)); I 81%; = 0.0008]. Furthermore, CFS 6-9 patient group displayed an even more noticeable mortality increase when compared to patients with CFS 1-3 [(RE) OR 3.09 (2.03, 4.71); I 87%; <0.0001]. Generic inverse variance analysis of adjusted hazard ratio among included studies highlighted that CFS ( = 0.0001), male gender ( = 0.0009), National Early Warning Score ( = 0.0001), Ischaemic Heart Disease (IHD) ( = 0.07), Hypertension (HT) (<0.0001), and Chronic Kidney Disease (CKD) ( = 0.0009) were associated with increased COVID-19 mortality.
Our findings suggest a differential stratification of CFS scores in the context of COVID-19 infection, in which CFS 1-3 patients may be considered at lower risk, CFS 4-5 at moderate risk, and CFS 6-9 at high risk of mortality regardless of age. Overall, our study not only aims to alert clinicians of the value of CFS scores, but also highlight the multiple dimensions to consider such as age, gender and co-morbidities, even among moderately frail patients in relation to COVID-19 mortality.
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新型冠状病毒肺炎（COVID-19）已导致自1918年以来最大规模的疫情，全球死亡人数超过200万。体弱和老年人的死亡风险最高。本研究的主要目的是通过增加虚弱程度来量化临床虚弱量表（CFS）的影响，并确定与COVID-19死亡率增加相关的其他个人预后因素。
本研究提供了一项当代系统评价和荟萃分析，以分析按CFS子类别增加（1-3、4-5和6-9）分层的死亡风险。检索的数据库包括EMBASE、MEDLINE、CAB文摘、PsychInfo和科学网，最终检索截止日期为2020年12月18日。2021年3月23日，在同行评审数据库搜索中对通过MedRevix识别的出版物进行了跟进，并根据发表情况更新了引用。纳入了报告CFS与COVID-19死亡率之间关联的前瞻性和回顾性队列研究。34项研究符合系统评价标准，17项符合荟萃分析标准，异质性为81%-87%（I）。
所有研究[N：34]纳入了来自医院环境的患者，共18042例，平均年龄72.8岁（最小：56岁；最大：86岁）。与CFS 1-3的患者相比，CFS 4-5的患者组死亡率显著增加[（RE）OR 1.95（1.32（95%CI），2.87（95%CI））；I 81%；P = 0.0008]。此外，与CFS 1-3的患者相比，CFS 6-9的患者组死亡率增加更为明显[（RE）OR 3.09（2.03，4.71）；I 87%；P <0.0001]。纳入研究中调整后风险比的一般逆方差分析强调，CFS（P = 0.0001）、男性（P = 0.0009）、国家早期预警评分（P = 0.0001）、缺血性心脏病（IHD）（P = 0.07）、高血压（HT）（P <0.0001）和慢性肾脏病（CKD）（P = 0.0009）与COVID-19死亡率增加相关。
我们的研究结果表明，在COVID-19感染的背景下，CFS评分存在差异分层，其中CFS 1-3的患者可被视为低风险，CFS 4-5为中度风险，CFS 6-9为高死亡风险，无论年龄如何。总体而言，我们的研究不仅旨在提醒临床医生CFS评分的价值，还强调了需要考虑的多个维度，如年龄、性别和合并症，即使是在与COVID-19死亡率相关的中度体弱患者中。
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