The relationship between frailty, nutritional status, co-morbidity, CT-body composition and systemic inflammation in patients with COVID-19

Abstract

Background Frailty, determined by the Canadian Study of Health and Aging-Clinical Frailty Scale (CFS), is strongly associated with clinical outcomes including mortality in patients with COVID-19. However, the relationship between frailty and other recognised prognostic factors including age, nutritional status, obesity, sarcopenia and systemic inflammation is poorly understood. Therefore, the aim of this study was to examine the relationship between frailty and other prognostic domains, in patients admitted with COVID-19. Methods Patients who presented to our institutions between 1st April 2020–6th July 2020 with confirmed COVID-19 were assessed for inclusion. Data collected included general demographic details, clinicopathological variables, CFS admission assessment, Malnutrition Universal Screening Tool (MUST), CT-BC measurements and markers of systemic inflammation. Results 106 patients met the study inclusion criteria. The majority of patients were aged ≥ 70 years (67%), male (53%) and frail (scoring > 3 on the CFS, 72%). The majority of patients were not malnourished (MUST 0, 58%), had ≥ 1 co-morbidity (87%), were sarcopenic (low SMI, 80%) and had systemic inflammation (mGPS ≥ 1, 81%, NLR > 5, 55%). On multivariate binary logistics regression analysis, age (p < 0.01), COPD (p < 0.05) and NLR (p < 0.05) remained independently associated with frailty. On univariate binary logistics regression, NLR (p < 0.05) was significantly associated with 30-day mortality. Conclusion Frailty was independently associated with age, co-morbidity, and systemic inflammation. The basis of the relationship between frailty and clinical outcomes in COVID-19 requires further study. Trial registration Registered with clinicaltrials.gov (NCT04484545)

Prevalence of Sarcopenia in Patients With COVID-19: A Systematic Review and Meta-Analysis

“…Figure 1 presents the PRISMA diagram for the study selection and reasons for exclusion. (25,30,50,51), 2 from France (43,49), 3 from the United Kingdom (27,48,53), 1 from Germany (52), and 1 from Netherlands (45)], and the rest of included studies (7/21) included individuals from Asia [3 from China (31,33,46), 2 from Turkey (26,32), and 1 from South Korea (42)] and North America [2 from Mexico (29,47)]. Only three included studies had a cross-sectional design (32,44,50), and the remaining eighteen studies were observational cohort studies (25-27, 29-31, 33, 41-43, 45-49, 51-53).…”

“…Of these, 3,338 articles were excluded after screening the titles and abstracts, leaving 151 articles for full-text review. Finally, 21 articles ( n = 5,407 patients with COVID-19) ( 25 – 27 , 29 – 33 , 41 – 53 ) were included in the systematic review and meta-analysis finally. Figure 1 presents the PRISMA diagram for the study selection and reasons for exclusion.…”

“…The 21 included studies comprised of 5,407 patients with COVID-19 with the mean age ranging from 44.5 to 86.1 years. Most studies (14/21) included individuals from Europe [2 from Spain ( 41 , 44 ), 4 from Italy ( 25 , 30 , 50 , 51 ), 2 from France ( 43 , 49 ), 3 from the United Kingdom ( 27 , 48 , 53 ), 1 from Germany ( 52 ), and 1 from Netherlands ( 45 )], and the rest of included studies (7/21) included individuals from Asia [3 from China ( 31 , 33 , 46 ), 2 from Turkey ( 26 , 32 ), and 1 from South Korea ( 42 )] and North America [2 from Mexico ( 29 , 47 )]. Only three included studies had a cross-sectional design ( 32 , 44 , 50 ), and the remaining eighteen studies were observational cohort studies ( 25 – 27 , 29 – 31 , 33 , 41 – 43 , 45 – 49 , 51 – 53 ).…”

“…Most studies (14/21) included individuals from Europe [2 from Spain ( 41 , 44 ), 4 from Italy ( 25 , 30 , 50 , 51 ), 2 from France ( 43 , 49 ), 3 from the United Kingdom ( 27 , 48 , 53 ), 1 from Germany ( 52 ), and 1 from Netherlands ( 45 )], and the rest of included studies (7/21) included individuals from Asia [3 from China ( 31 , 33 , 46 ), 2 from Turkey ( 26 , 32 ), and 1 from South Korea ( 42 )] and North America [2 from Mexico ( 29 , 47 )]. Only three included studies had a cross-sectional design ( 32 , 44 , 50 ), and the remaining eighteen studies were observational cohort studies ( 25 – 27 , 29 – 31 , 33 , 41 – 43 , 45 – 49 , 51 – 53 ). A total of eleven included studies ( n = 1,603 patients with COVID-19) described the specific sarcopenia events between male and female patients with COVID-19 ( 26 , 29 – 31 , 42 , 43 , 47 , 49 – 52 ).…”

“…For sarcopenia assessment methods, five studies (26,30,33,42,47) (32,50) and BIA (48,51), which were used by two studies each and yielded a pooled prevalence of 26.7 (95% CI: 23.2 to 30.5%, k = 2, I 2 = 98.90%, p = 0.000) and 0.4% (95% CI: 0.1 to 0.8%, k = 2, I 2 = 97.70%, p = 0.000), respectively. For parameters used to measure sarcopenia, seven studies used skeletal muscle index (SMI) with a pooled prevalence of 49.0% (95% CI: 31.3 to 66.9%, k = 7, I 2 = 97.03%, p = 0.000) (25,29,33,42,47,52,53), 4 studies used SARF-score with a prevalence of 73% (95% CI: 49.3 to 91.3%, k = 4, I 2 = 98.00%, p = 0.000) (31,41,44,45), and two studies used HGS with a prevalence of 26.7% (95% CI: 23.2 to 30.5%, k = 2, I 2 = 98.90%, p = 0.000) (32,50). The subgroup meta-analysis result of parameters used in the remaining studies is shown in Table 3 and Supplementary Figure 6.…”