tetano
Editor, Senior Moderator
Arch Gerontol Geriatr
. 2020 Dec 15;93:104324.
doi: 10.1016/j.archger.2020.104324. Online ahead of print.
Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis
Raymond Pranata[SUP] 1 [/SUP], Joshua Henrina[SUP] 2 [/SUP], Michael Anthonius Lim[SUP] 3 [/SUP], Sherly Lawrensia[SUP] 4 [/SUP], Emir Yonas[SUP] 5 [/SUP], Rachel Vania[SUP] 6 [/SUP], Ian Huang[SUP] 7 [/SUP], Antonia Anna Lukito[SUP] 8 [/SUP], Ketut Suastika[SUP] 9 [/SUP], R A Tuty Kuswardhani[SUP] 10 [/SUP], Siti Setiati[SUP] 11 [/SUP]
Affiliations
Abstract
Introduction: 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.
Methods: 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.
Results: 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[SUP]2[/SUP]: 77.3%). The dose-response relationship was linear (P[SUB]non-linearity[/SUB]=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].
Conclusion: This meta-analysis showed that increase in CFS was associated with increase in mortality in a linear fashion.
Keywords: Age; COVID-19; Coronavirus; Frailty; Prognosis; Risk stratification.
. 2020 Dec 15;93:104324.
doi: 10.1016/j.archger.2020.104324. Online ahead of print.
Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis
Raymond Pranata[SUP] 1 [/SUP], Joshua Henrina[SUP] 2 [/SUP], Michael Anthonius Lim[SUP] 3 [/SUP], Sherly Lawrensia[SUP] 4 [/SUP], Emir Yonas[SUP] 5 [/SUP], Rachel Vania[SUP] 6 [/SUP], Ian Huang[SUP] 7 [/SUP], Antonia Anna Lukito[SUP] 8 [/SUP], Ketut Suastika[SUP] 9 [/SUP], R A Tuty Kuswardhani[SUP] 10 [/SUP], Siti Setiati[SUP] 11 [/SUP]
Affiliations
- PMID: 33352430
- DOI: 10.1016/j.archger.2020.104324
Abstract
Introduction: 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.
Methods: 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.
Results: 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[SUP]2[/SUP]: 77.3%). The dose-response relationship was linear (P[SUB]non-linearity[/SUB]=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].
Conclusion: This meta-analysis showed that increase in CFS was associated with increase in mortality in a linear fashion.
Keywords: Age; COVID-19; Coronavirus; Frailty; Prognosis; Risk stratification.