Exploratory Study Examining A Composite Index Measuring Sarcopenia and Anxiety in COPD – Relationship with Frailty, Disease Severity, Exertional Dyspnea and Quality of Life.

Abstract

Recent models of palliative care for COPD shifted from care-provision at the end of life, to emphasizing early integration when symptom burden significantly impairs quality of life (QOL). Sarcopenia was recently shown to associate with reduced exercise capacity, functional performance and health status. Similarly, anxiety is related with poorer QOL, more exacerbations, more re-hospitalizations, prolonged length of stay and higher mortality in COPD. We hypothesize that a bi-dimensional index comprising measurement of sarcopenia and anxiety – SARA score, can identify frailer patients with high symptom burden and significantly diminished QoL, for early palliative care. A feasibility study comprising 33 subjects with stage 2-4 COPD are recruited. The SARA scale comprises the SARC-F questionnaire that measures sarcopenia, as well as the anxiety domain of the Hospital Anxiety and Depression Scale (HADS). A composite score derived from the two indices forms the SARA score that ranges 2-6 points. Correlational analyses examined relationships between SARA and markers of frailty (Fried Index, FRAIL questionnaire), exertional dyspnea (eMRCD scale), QoL (Chronic Respiratory Questionnaire, CRQ) and disease severity (CAT score). Univariate analyses were employed to compare the mean score of the above variables between 2 groups (SARA 3 vs SARA <3). Subjects had a mean age of 70. 25 (75.8%) have stage 3 and 4 COPD. SARA score demonstrates moderate correlation with eMRCD, CAT, FRAIL and Fried scores, as well as the fatigue, emotional function and mastery domain of the CRQ (all p<0.05). Additionally, it highly correlated with the depression domain of HADS (HADS-D) (p<0.001). Univariate analyses demonstrate that SARA 3 is significantly associated with greater eMRCD, CAT score, FRAIL, Fried’s index, HADS-D and the three domain of CRQ listed above. Preliminary analysis suggest that the SARA may help identify subjects with greater frailty, more severe disease, higher psychological morbidity and poorer QoL, for early palliative multi-disciplinary interventions.