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

Jia Luo, Dai Zhang, Wen Tang, Li-Yang Dou, Ying Sun, Jia Luo, Dai Zhang, Wen Tang, Li-Yang Dou, Ying Sun

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; acute exacerbation; frailty; mortality; older adults.

Conflict of interest statement

The authors report no conflicts of interest for this work.

© 2021 Luo et al.

Figures

Figure 1
Figure 1
Distribution of frailty phenotypic characteristics assessed using Fried frailty phenotypes in older patients with stable chronic obstructive pulmonary disease (COPD).
Figure 2
Figure 2
Comparison of unadjusted and adjusted survival curves of patients age ≥ 65 years with stable COPD stratified according to frailty (Fried phenotype score ≥ 3). (A) Unadjusted Kaplan–Meier curve. (B) Survival curves adjusted by age, gender, CCI, medication, GOLD severity, moderate-to-severe exacerbation history, and CAT. Frail patients had a higher mortality.

References

    1. Vogelmeier CF, Criner GJ, Martinez FJ, et al. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report. GOLD Executive Summary. Am J Respir Crit Care Med. 2017;195(5):557–582. doi:10.1164/rccm.201701-0218PP
    1. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;394(10204):1145–1158. doi:10.1016/S0140-6736(19)30427-1
    1. Dent E, Martin FC, Bergman H, et al. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394(10206):1376–1386. doi:10.1016/S0140-6736(19)31785-4
    1. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–M56. doi:10.1093/gerona/56.3.M146
    1. Lahousse L, Ziere G, Verlinden VJA, et al. Risk of frailty in elderly with COPD: a population-based study. J Gerontol A Biol Sci Med Sci. 2016;71(5):689–695. doi:10.1093/gerona/glv154
    1. Marengoni A, Vetrano DL, Manes-Gravina E, et al. The relationship between COPD and frailty: a Systematic Review and Meta-Analysis of Observational Studies. Chest. 2018;154(1):21–40. doi:10.1016/j.chest.2018.02.014
    1. Vaz Fragoso CA, Enright PL, McAvay G, et al. Frailty and respiratory impairment in older persons. Am J Med. 2012;125(1):79–86. doi:10.1016/j.amjmed.2011.06.024
    1. Maddocks M, Kon SSC, Canavan JL, et al. Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study. Thorax. 2016;71(11):988–995. doi:10.1136/thoraxjnl-2016-208460
    1. Mittal N, Raj R, Islam EA, et al. The frequency of frailty in ambulatory patients with chronic lung diseases. J Prim Care Community Health. 2016;7(1):10–15. doi:10.1177/2150131915603202
    1. Park SK, Richardson CR, Holleman RG, et al. Frailty in people with COPD, using the National Health and Nutrition Evaluation Survey dataset (2003–2006). Heart Lung. 2013;42(3):163–170. doi:10.1016/j.hrtlng.2012.07.004
    1. Mirza S, Benzo R. Chronic obstructive pulmonary disease phenotypes: implications for care. Mayo Clin Proc. 2017;92(7):1104–1112. doi:10.1016/j.mayocp.2017.03.020
    1. Hoogendijk EO, Afilalo J, Ensrud KE, et al. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365–1375. doi:10.1016/S0140-6736(19)31786-6
    1. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. doi:10.1016/0021-9681(87)90171-8
    1. Rubenstein LZ, Harker JO, Salvà A, et al. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF). J Gerontol A Biol Sci Med Sci. 2001;56(6):M366–72. doi:10.1093/gerona/56.6.M366
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–186. doi:10.1093/geront/9.3_Part_1.179
    1. Ehsani H, Mohler MJ, Golden T, et al. Upper-extremity function prospectively predicts adverse discharge and all-cause COPD readmissions: a pilot study. Int J Chron Obstruct Pulmon Dis. 2019;14:39–49. doi:10.2147/COPD.S182802
    1. Kennedy CC, Novotny PJ, LeBrasseur NK, et al. Frailty and clinical outcomes in chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2019;16(2):217–224. doi:10.1513/AnnalsATS.201803-175OC
    1. Davalos-Yerovi V, Marco E, Sánchez-Rodríguez D, et al. Sarcopenia according to the revised European Consensus on definition and diagnosis (EWGSOP2) criteria predicts hospitalizations and long-term mortality in rehabilitation patients with stable chronic obstructive pulmonary disease. J Am Med Dir Assoc. 2019;20(8):1047–1049. doi:10.1016/j.jamda.2019.03.019
    1. Petermann-Rocha F, Chen MH, Gray SR, et al. New versus old guidelines for sarcopenia classification: what is the impact on prevalence and health outcomes? Age Ageing. 2020;49(2):300–304. doi:10.1093/ageing/afz126
    1. Costanzo L, Vincentis AD, Iorio AD, et al. Impact of Low muscle mass and low muscle strength according to EWGSOP2 and EWGSOP1 in Community-Dwelling older people. J Gerontol A Biol Sci Med Sci. 2020;75(7):1324–1330. doi:10.1093/gerona/glaa063
    1. Cruz-Jentoft AJ, Sayer AA. Sarcopenia. Lancet. 2019;393(10191):2636–2646. doi:10.1016/S0140-6736(19)31138-9
    1. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. doi:10.1093/ageing/afy169
    1. van Helvoort HA, Heijdra YF, de Boer RC, et al. Six-minute walking-induced systemic inflammation and oxidative stress in muscle-wasted COPD patients. Chest. 2007;131(2):439–445. doi:10.1378/chest.06-1655
    1. Bone AE, Hepgul N, Kon S, et al. Sarcopenia and frailty in chronic respiratory disease. Chron Respir Dis. 2017;14(1):85–99. doi:10.1177/1479972316679664
    1. Shrikrishna D, Patel M, Tanner RJ, et al. Quadriceps wasting and physical inactivity in patients with COPD. Eur Respir J. 2012;40(5):1115–1122. doi:10.1183/09031936.00170111
    1. Jaitovich A, Barreiro E. Skeletal muscle dysfunction in chronic obstructive pulmonary disease. What we know and can do for our patients. Am J Respir Crit Care Med. 2018;198(2):175–186. doi:10.1164/rccm.201710-2140CI
    1. Poberezhets V, Mostovoy Y, Demchuk H. Exacerbation of chronic obstructive pulmonary diseases as a risk factor of the skeletal muscle dysfunction. Lung India. 2019;36(3):188–192. doi:10.4103/lungindia.lungindia_185_18
    1. Bernabeu-Mora R, García-Guillamón G, Valera-Novella E, et al. Frailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal study. Ther Adv Respir Dis. 2017;11(10):383–392. doi:10.1177/1753465817726314
    1. Han MK, Agusti A, Calverley PM, et al. Chronic obstructive pulmonary disease phenotypes: the future of COPD. Am J Respir Crit Care Med. 2010;182(5):598–604. doi:10.1164/rccm.200912-1843CC
    1. Brighton LJ, Evans CJ, Man WDC, et al. Improving exercise-based interventions for people living with both COPD and frailty: a realist review. Int J Chron Obstruct Pulmon Dis. 2020;20(15):841–855. doi:10.2147/COPD.S238680
    1. Collins PF, Yang IA, Chang YC, et al. Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update. J Thorac Dis. 2019;11(Suppl 17):S2230–S7. doi:10.21037/jtd.2019.10.41
    1. Tessier AJ, Chevalier S. An update on protein, Leucine, Omega-3 fatty acids, and vitamin D in the prevention and treatment of sarcopenia and functional decline. Nutrients. 2018;10(8):1099. doi:10.3390/nu10081099
    1. Miravitlles M, Calle M, Soler-Cataluña JJ. Clinical phenotypes of COPD: identification, definition and implications for guidelines. Arch Bronconeumol. 2012;48:86–98. doi:10.1016/j.arbres.2011.10.007

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