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Table 1 Characteristics of included studies

From: Clinical Frailty Scale (CFS) indicated frailty is associated with increased in-hospital and 30-day mortality in COVID-19 patients: a systematic review and meta-analysis

Study Origin Recruitment period Study type Frailty Scale Frailty assessment Inclusion criteria No. of patients Age (years) Sex Outcomes
Age (years) COVID-19 diagnosis Total Deceased Mean/Median SD/IQ1–3 Male n (%)
Aliberti et al. [28] Brazil 30.03.2020–07.07.2020 R/C CFS R/P+ > 50y PCR 1830 666 66 59–74 1061 (38) 30-day mortality
Andrés-Esteban et al. [29] Spain 15.07.2020–31.07.2020 R/C CFS R/P+ 0–97 PCR 254 104 70.16 16.01 155 (61) In-hospital mortality; frailty diff. for in-hospital mort.; ICU admission; LOH
Apea [30] UK 01.01.2020–13.05.2020 P/C CFS, HFRS R > 16 PCR 831 315 n/a n/a n/a 30-day mortality
Aw [31] UK 01.03.2020–30.04.2020 R/C CFS R/P+ > 65 PCR or Clin or Rad 677 271 81.1 8.1 366 (54.1) In-hospital mortality, ICU admission
Baker et al. [32] UK 31.01.2020–16.04.2020 R/C CFS R > 18y PCR 316 84 75 60–83 173 (54.7) Frailty diff. for 30-day mort
Bavaro et al. [33] Italy 01.03.2020–15.06.2020 R/C CFS R/P+ > 65y PCR 206 56 80 72–86 98 (48) In-hospital mortality; LOH
Bielza [34] Spain 20.03.2020–01.06.2020 R/C CFS P+ > 70 PCR or Clin 630 282 87 82.9–91.1 223 (35.4) 30-day mortality, frailty diff. for 30-day mort. and severe vs non-severe cases
Blomaard [35] Netherlands 27.02.2020–14.05.2020 R/C CFS R/P+ > 70 PCR or Clin or Rad 1376 499 78 74–84 830 (60.4) In-hospital mortality, ICU admission, LOH, invasive ventilation, delirium, discharge destination
Bradley [36] UK 01.04.2020–14.04.2020 P/C CFS P n/r PCR 830 300 70 58–80 509 (61.3) 30 day mortality, frailty diff. for 30-day mortality and 72 h mortality
Brill [37] UK 10.03.2020–08.04.2020 R/C CFS P n/r PCR 450 173 72 56–83 272 (60) Frailty diff. for in-hospital mortality
Burns [38] UK 13.03.2020–22.04.2020 R/C CFS P n/r PCR 28 14 81.5 54–91 15 (54) In-hospital mortality; frailty diff. for in-hospital mortality and duration of respiratory support
Cecchini et al. [39] Italy 01.03.2020–30.04.2020 R/C CFS R > 65y PCR/CXR 122   87.1 6 55 (45.1) Frailty diff. for in-hospital mort
Chinnadurai [40] UK 13.03.2020–30.04.2020 R/C CFS P n/r PCR 215 86 74 60–82 133 (61.9) In-hospital mortality
Covino [41] Italy 01.0.4.2020–30.03.2021 P/C CFS P > 80y PCR 729 287 85 82–89 345 (47.3) In-hospital mortality
Cuvelier [42] Switzerland 13.03.2020–11.05.2020 R/C CFS R > 80y NR 20 10 87,1 82.8–90.6 14 (70) Frailty diff. for in-hospital mort
Davis [43] UK 18.03.2020–20.04.2020 R/C CFS R n/r PCR 222 95 82 56–99 74 (33) 30-day mortality
De Smet [44] Belgium 12.03.2020–30.04.2020 R/C CFS P+ n/r PCR 81 19 85 81–90 33 (41) In-hospital mortality, frailty diff. for in-hospital mortality
Dres et al. [45] France, Switzerland, Belgium 25.02.2020–04.05.2020 P/C CFS P > 70y PCR 1199 442 74 71–77 873 (72.8) 30-day mortality
Fagard [46] Belgium 16.03.2020–16.05.2020 R/C CFS P+ > 70 PCR or Clin and CT 105 14 82 76–87 55 (52.4) In-hospital mortality, frailty diff. for in-hospital mortality
Fallon et al. [47] Ireland 25.03.2020–24.04.2020 R/C CFS R/P+ > 65y PCR 86 29 77   n/r Frailty diff. for 30-day mort
Fumagalli et al. [48] Italy 22.02.2020–30.05.2020 R/C mFI R > 75y Clin 221 97 82 78–86 134 (60.6) In-hospital mortality
Gilis [49] France 03.03.2020–25.04.2020 P/C CFS P > 75 PCR 186 56 85.3 5.78 92 (49.5) 30-day mortality, ICU admission, laboratory findings, symptoms, delirium, treatment
Hewitt [50] UK, Italy 27.02.2020–28.04.2020 P/C CFS P+ > 18 PCR or Clin 1564 425 74 61–83 903 (57.7) In-hospital mortality; LOH
Hoek [51] Netherland 27.02.2020–30.04.2020 R/C CFS R n/r PCR 23 5 n/a n/a 18 (78.3) Frailty diff. for in-hospital mortality (solid organ transplant recipients)
Jung et al. [52] Austria, Belgium, Denmark, Egypt, England, France, Germany, Greece, India, Iran, Iraq, Ireland, Israel, Italy, Libya, Mexico, Morocco, Netherland, Norway, Poland, Portugal, Saudi Arabia, Spain, Sudan, Switzerland, USA 19.03.2020–26.05.2020 P/C CFS P+ > 70y PCR 1346 540 75 72–78 965 (71.7) 30-day mortality
Knights [53] UK 01.03.2020–31.03.2020 R/C CFS R n/r PCR 108 34 68.7 1.5 63 (58) Frailty diff. for in-hospital mortality
Koduri et al. [54] UK 20.02.2020–07.05.2020 R/C CFS R > 18y PCR or Clin + CT 500 193 69,39 17,2 300 (60) Frailty diff. for in-hospital mort
Kundi [55] Turkey 11.03.2020–22.06.2020 R/C HFRS R > 65 PCR 18,234 3315 74.1 7.4 8498 (46.6) in-hospital mortality; Frailty diff. for in-hospital mortality; LOH
Kurtz et al. [56] Brazil 27.02.2020–28.10.2020 P/C mFI P > 18y PCR 13,301 1785 54 41–69 7752 (58) 30-day mortality
Lozano-Montoya et al. [57] Spain 03.2020–05.2020 R/C CFS R > 75y PCR or Clin + CT 300 111 86.3 6.6 112 (37.3) In-hospital mortality
Maguire et al. [58] UK 18.05.2020–06.07.2020 R/C CFS n/r > 16y PCR 261 58    119 (46) 30-day mortality
Maki et al. [59] Japan 02.2020–05.2020 R/C MPI R > 65y PCR 18 4 82.89 10.2 7 (38.9) In-hospital mortality
Marengoni [60] Italy 08.03.2020–17.04.2020 R/C CFS R n/r PCR or CT 165 42 69.3 14.5 100 (60.6) In-hospital mortality, ICU admission
McWilliams [61] UK 03.2020–04.2020 P/C CFS P > 18 n/a 177 67 n/a n/a 127 (71.8) In-hospital mortality, ICU mortality, ICU rehabilitation (only ICU patients)
Mendes [62] Switzerland 13.03.2020–14.04.2020 R/C CFS R > 65 PCR or Clin and Rad 235 76 86.3 6.5 102 (43.4) In-hospital mortality, frailty diff. for in-hospital mortality
Moledina [63] UK 23.03.2020–07.04.2020 R/C CFS R n/r PCR 229 75 73 56–81 144 (63) Frailty diff. for 30-day mortality
Moloney [64] Ireland 17.02.2020–24.04.2020 R/C CFS R > 70 PCR 69 16 79 75–85 40 In-hospital mortality; symptoms, COVID-19 severity, radiological findings, ventilation
Navaratnam et al. [65] UK 01.03.2020–31.05.2020 R/C HFRS R > 18y PCR 91,541 28,200    50,668 (55.4) In-hospital mortality
Noble et al. [66] UK 03.2020–06.2020 R/C CFS n/r > 18y PCR or Clin 164 68 62.1   110 (61.1) in-hospital mortality
Osuafor [67] UK 01.03.2020–15.05.2020 R/C CFS R > 65 PCR or Clin 214 74 80.3 8.3 120 (56.1) In-hospital mortality, ICU admission, LOH, readmission; delirium, mobility at discharge, prolonged LOH, death within 14 days of discharge
Owen [68] UK 29.02.2020–16.04.2020 R/C CFS R > 65 PCR 206 92 78.8 8.3 n/a 30-day mortality, ICU admission, ICU mortality
Piers [69] Belgium 03.2020–04.2020 R/C CFS R > 80 n/a 711 246 n/a n/a n/a In-hospital mortality, ICU admission
Pilotto et al. [70] Italy 31.01.2020–31.12.2020 P/C MPI P > 65y PCR 227 43 80.5   93 (41) In-hospital mortality
Ponsford et al. [71] UK 01.03.2020–01.07.2020 R/C CFS P > 18y PCR 2508 885 74 62.5–85.5 1363 (54.3) In-hospital mortality
Ramos-Rincon et al. [72] Spain 03.03.2020–02.05.2020 R/C CFS, HFRS R > 18y PCR 290 48     In-hospital mortality; ICU admission; LOH
Sablerolles et al. [73] Austria, Belgium, Denmark, France, Germany, Italy, Netherlands, Portugal, Spain, Switzerland, UK 30.03.2020–15.07.2020 R/C CFS P > 18y PCR or Clin + CT 2434 456 67 55–77 1480 (61) In-hospital mortality;ICU admission
Steinmeyer [74] France 13.03.2020–04.05.2020 R/C FIND R n/r PCR or Clin and CT 94 17 85.5 7.5 42 (44.6) In-hospital mortality
Straw [75] UK 05.03.2020–07.05.2020 R/C CFS R > 18 PCR 485 159 71.2 16.9 259 (45.8) Frailty diff. for in-hospital mortality
Tehrani [76] Sweden 05.03.2020–28.04.2020 R/C CFS R n/r PCR 255 70 66 17 150 (59) In-hospital mortality, ventilation
Thiam et al. [77] Malaysia 25.02.2020–27.05.2020 R/C CFS R > 60y Clin 26 6 76.2 8.2 11 (42.3) In-hospital mortality
van Steenkiste et al. [78] Netherland 09.03.2020–01.05.2020 R/C CFS R > 18y n/r 32 24 79 74.5–83 22 (69) Frailty diff. for in-hospital mort
Verholt et al. [79] Denmark 01.03.2020–31.05.2020 R/C MPI R > 75y Clin 100 37 82 77–84 44 (44) In-hospital mortality; 30-day and 90-day mortality
Welch et al. [80] Egypt, Spain, UK, Greece Ireland, Iraq, Italy, Libya, Saudi Arabia, Sudan, Turkey, USA n/r P/C + R/C CFS R/P > 18y PCR or Clin 5711 1596 74 58–83 3149 (55.1) In-hospital mortality
Wolfisberg et al. [81] Switzerland 26.02.2020–30.04.2020 and 01.10.2020–31.12.2020 R/C CFS R/P > 18y PCR or Clin + rAT 486 92 65.9 14.7 317 (65.2) In-hospital mortality; frailty diff. for in-hospital mort.; ICU admission
  1. Highlighted studies are included in the quantitative analyses. Age is reported using mean ± SD, or median (IQ 1–3) except: Davis P.R. where data was reported as mean (range). The method of frailty assessment was indicated by P for prospective and R in case of retrospective assessment. In case of prospective frailty assessment, if information about the training of the assessor was disclosed, it is marked by ‘+’
  2. n/a not available, n/r no restriction, P/C prospective cohort, R/C retrospective cohort, CFS Clinical Frailty Scale, HFRS Hospital Frailty Risk Score, FiND Frail Non-Disabled questionnaire, PCR polymerase chain reaction, Clin diagnosis based on clinical suspicion, Rad radiologically suspected diagnosis, CT computer tomography based diagnosis, CXR chest X-rax, rAT rapid antigen test, SD standard deviation, IQ interquartile, OR odds ratio, ICU intensive care unit, LOH length of hospitalization, UK United Kingdom