Dataset Information

Clinical frailty scale as a point of care prognostic indicator of mortality in COVID-19: a systematic review and meta-analysis.

ABSTRACT:

Background

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.

Methods

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% (I²) heterogeneity.

Findings

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)); I² 81%; p = 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); I² 87%; p<0.0001]. Generic inverse variance analysis of adjusted hazard ratio among included studies highlighted that CFS (p = 0.0001), male gender (p = 0.0009), National Early Warning Score (p = 0.0001), Ischaemic Heart Disease (IHD) (p = 0.07), Hypertension (HT) (p<0.0001), and Chronic Kidney Disease (CKD) (p = 0.0009) were associated with increased COVID-19 mortality.

Interpretation

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.

Funding

None.

SUBMITTER: Kastora S

PROVIDER: S-EPMC8141355 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:COVID-19 pandemic has posed serious risk of contagion to humans. There is a need to find reliable non-contact tests like vocal correlates of COVID-19 infection. Thirty-six Asian ethnic volunteers 16 (8M & 8F) infected subjects and 20 (10M &10F) non-infected controls participated in this study by vocalizing vowels /a/, /e/, /i/, /o/, /u/. Voice correlates of 16 COVID-19 positive patients were compared during infection and after recovery with 20 non-infected controls. Compared to non-infected controls, significantly higher values of energy intensity for /o/ (p = 0.048); formant F1 for /o/ (p = 0.014); and formant F3 for /u/ (p = 0.032) were observed in male patients, while higher values of Jitter (local, abs) for /o/ (p = 0.021) and Jitter (ppq5) for /a/ (p = 0.014) were observed in female patients. However, formant F2 for /u/ (p = 0.018), mean pitch F0 for /e/, /i/ and /o/ (p = 0.033; 0.036; 0.047) decreased for female patients under infection. Compared to recovered conditions, HNR for /e/ (p = 0.014) was higher in male patients under infection, while Jitter (rap) for /a/ (p = 0.041); Jitter (ppq5) for /a/ (p = 0.032); Shimmer (local, dB) for /i/ (p = 0.024); Shimmer (apq5) for /u/ (p = 0.019); and formant F4 for vowel /o/ (p = 0.022) were higher in female patients under infection. However, HNR for /e/ (p = 0.041); and formant F1 for /o/ (p = 0.002) were lower in female patients compared to their recovered conditions. Obtained results support the hypothesis since changes in voice parameters were observed in the infected patients which can be correlated to a combination of acoustic measures like fundamental frequency, formant characteristics, HNR, and voice perturbations like jitter and shimmer for different vowels. Thus, voice analysis can be used for scanning and prognosis of COVID-19 infection. Based on the findings of this study, a mobile application can be developed to analyze human voice in real-time to detect COVID-19 symptoms for remedial measures and necessary action.