Impact of Frailty (Clinical Frailty Scale) on Weaning from Mechanical Ventilation: A Systematic Review and Meta-analysis

Background and aims:Frailty is a multidimensional syndrome marked by reduced physiological reserve and increased vulnerability to stress, often seen in critically ill patients.It may affect outcomes such as weaning from mechanical ventilation.It has been associated with adverse intensive care unit (ICU) outcomes, but its relationship with liberation from mechanical ventilation remains unclear.This study systematically reviewed and meta-analyzed the association between frailty Clinical Frailty Scale (CFS) and weaning outcomes in mechanically ventilated patients, hypothesizing worse outcomes with higher frailty.Methods: We systematically searched PubMed, Cochrane Library, ScienceDirect, KoreaMed, Google Scholar, and Semantic Scholar from inception for studies assessing frailty using the CFS and reporting weaning outcomes in mechanically ventilated ICU patients.Effect sizes were pooled as log odds ratios (OR) using a random-effects model.Risk of bias and certainty of evidence were evaluated using risk of bias in nonrandomized studies -of exposure (ROBINS-E) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools.Results: Seven observational studies, including 13,746 patients, met the inclusion criteria.Frailty was associated with higher odds of weaning failure (OR: 2.52, 95% confidence interval: 1.46-4.34;p = 0.001; k = 7; prediction interval: 0.75-8.47).Substantial heterogeneity (I = 92.9%),high risk of bias, inconsistency, and potential publication bias were noted.Associations were directionally consistent across subgroups and sensitivity analyses.The certainty of evidence was very low.Conclusion: Frailty appears to be associated with an increased risk of weaning failure, with approximately 2.5-fold higher odds observed in pooled analysis, supporting its role as a potential prognostic marker in clinical decision-making.However, the certainty of evidence is very low, with substantial heterogeneity, risk of bias, and possible residual confounding.These findings should be considered hypothesis-generating and underscore the need for standardized weaning definitions and well-designed prospective studies to better evaluate frailty's predictive value.