• Ashwin Subramaniam, Kiran Shekar, Afsana Afroz, Sushma Ashwin, Baki Billah, Hamish Brown, Harun Kundi, Zheng Jie Lim, Ponnapa ReddyMallikarjunaMDepartment of Intensive Care Medicine, Peninsula Health, Melbourne, Victoria, Australia.Department of Intensive Care Medicine, Calvary Hospital, Canberra, Australian Capital Territory, Australia., and CurtisJ RandallJRCambia Palliative Care Centre of Excellence, University of Washington, Seattle, Washington, USA.Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, USA..
• Department of Intensive Care Medicine, Peninsula Health, Melbourne, Victoria, Australia.
• Intern Med J. 2022 May 1; 52 (5): 724-739.

BackgroundObservational data during the pandemic have demonstrated mixed associations between frailty and mortality.AimTo examine associations between frailty and short-term mortality in patients hospitalised with coronavirus disease 2019 (COVID-19).MethodsIn this systematic review and meta-analysis, we searched PubMed, Embase and the COVID-19 living systematic review from 1 December 2019 to 15 July 2021. Studies reporting mortality and frailty scores in hospitalised patients with COVID-19 (age ≥18 years) were included. Data on patient demographics, short-term mortality (in hospital or within 30 days), intensive care unit (ICU) admission and need for invasive mechanical ventilation (IMV) were extracted. The quality of studies was assessed using the Newcastle-Ottawa Scale.ResultsTwenty-five studies reporting 34 628 patients were included. Overall, 26.2% (n = 9061) died. Patients who died were older (76.7 ± 9.6 vs 69.2 ± 13.4), more likely male (risk ratio (RR) = 1.08; 95% confidence interval (CI): 1.06-1.11) and had more comorbidities. Fifty-eight percent of patients were frail. Adjusting for age, there was no difference in short-term mortality between frail and non-frail patients (RR = 1.04; 95% CI: 0.84-1.28). The non-frail patients were commonly admitted to ICU (27.2% (4256/15639) vs 29.1% (3567/12274); P = 0.011) and had a higher mortality risk (RR = 1.63; 95% CI: 1.30-2.03) than frail patients. Among patients receiving IMV, there was no difference in mortality between frail and non-frail (RR = 1.62; 95% CI 0.93-2.77).ConclusionThis systematic review did not demonstrate an independent association between frailty status and short-term mortality in patients with COVID-19. Patients with frailty were less commonly admitted to ICU and non-frail patients were more likely to receive IMV and had higher mortality risk. This finding may be related to allocation decisions for patients with frailty amidst the pandemic.© 2022 Monash University, Peninsula Clinical School. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

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