Clinical Interventions in Aging (Apr 2021)
Impact of Frailty on the Risk of Exacerbations and All-Cause Mortality in Elderly Patients with Stable Chronic Obstructive Pulmonary Disease
Abstract
Jia Luo, Dai Zhang, Wen Tang, Li-Yang Dou, Ying Sun Department of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of ChinaCorrespondence: Ying SunDepartment of Geriatrics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong’an Road, Xicheng District, Beijing, 100050, People’s Republic of ChinaTel + 86 10 63137737Fax + 86 10 63138795Email [email protected] ZhangDepartment of Geriatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of ChinaEmail [email protected]: 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
