Impact of Frailty on the Risk of Exacerbations and All-Cause Mortality in Elderly Patients with Stable Chronic Obstructive Pulmonary Disease

Abstract

Rationale

For the high prevalence of frail in patients with chronic obstructive pulmonary disease (COPD), further study should explore an in-depth understanding of the relationship between frailty and prognosis of COPD.

Objective

To determine the correlation between frailty and risk of acute exacerbation, hospitalizations, and mortality in older patients with stable COPD.

Participants and Methods

Consecutive older adults (≥65) diagnosed with stable COPD from January 2018 to July 2019, with an average follow-up of 546 days (N = 309). Frailty was defined by the Fried frailty phenotype. Poisson regression was performed to assess the influence of frailty on the incidence of acute exacerbations of COPD (AECOPD) and all-cause hospitalizations in a year. Cox regression was performed to evaluate the effect of frailty on all-cause mortality in patients with stable COPD.

Results

The prevalence of frailty was 49.8%. The most common phenotypic characteristics were weakness (99.4%) followed by slowness (92.9%). After adjustment, frailty increased the incidence of AECOPD (IRR = 1.75, 95% CI: 1.09–2.82) and all-cause hospitalizations (IRR = 1.39, 95% CI 1.04–1.87) within a year. Slowness was associated with AECOPD (IRR = 1.77, 95% CI: 1.03–3.03), and weakness was associated with increased all-cause hospitalizations (IRR = 1.53, 95% CI: 1.04–2.25). The all-cause mortality risk was more than twofold higher in frail patients (HR = 2.54, 95% CI: 1.01–6.36) than non-frail patients. Low physical activity (HR = 2.66, 95% CI: 1.17–6.05) and weight loss (HR = 2.15, 95% CI: 1.02–4.51) were significantly associated with increased all-cause mortality in patients with COPD.

Conclusion

Frailty increased the incidence of acute exacerbation and hospitalization, as well as increased mortality in older patients with stable COPD. This knowledge will help physicians identify high-risk groups with COPD and frailty who may benefit from targeted interventions to prevent disease progression.

Keywords:

• COPD
• frailty
• older adults
• acute exacerbation
• mortality

Acknowledgment

We acknowledge the role of all patients, investigators, and support staff in performing the study.

Abbreviations

COPD, Chronic Obstructive Pulmonary Disease; AECOPD, acute exacerbations of COPD; IRR, incidence rate ratio; aHR, adjusted hazard ratios; CI, confidence intervals; FEV1, forced expiratory volume in 1 second; GOLD, Global Initiative for COPD; FVC, forced vital capacity; BMI, body mass index; CAT, COPD Assessment Test; mMRC, modified Medical Research Council; FFP, Fried frailty phenotype; CCI, Charlson comorbidity index; MNA-SF, Mini Nutritional Assessment-Short Form; ADL, Katz Activities of Daily Living; IADL, Lawton Instrumental Activities of Daily Living; SD, standard deviation; IQR, interquartile range; BD, bronchodilator; ICS, inhaled corticosteroids; LABA, long-acting beta-agonists; LAMA, long-acting muscarinic antagonists.

Data Sharing Statement

Restrictions apply to the availability of data generated or analyzed during this study to preserve participant confidentiality. The corresponding author will on request detail the restrictions and any conditions under which access to some data may be provided.

Ethics Approval and Informed Consent

The research protocol of this study was approved by the Research Ethics Committee of Beijing Friendship Hospital and Capital Medical University (Beijing, China) and complied with the ethical guidelines of the Declaration of Helsinki (Project number: 2018-P2-137-01). All patients provided their signed informed consent before participating in this study.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest for this work.