Four different frailty models predict health outcomes in older patients with stable chronic obstructive pulmonary disease

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

doi:10.1186/s12877-022-02750-z

Dai Zhang, Wen Tang + Show 3 more

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https://doi.org/10.1186/s12877-022-02750-z

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Abstract

BackgroundFrail patients with chronic obstructive pulmonary disease (COPD) face a higher risk of adverse outcomes, but there is no clear consensus on which frailty measures are most suitable for COPD patients. Herein we evaluated the ability of frailty measurements in predicting 1-year acute exacerbation, hospitalization, and mortality in older patients with COPD.MethodsA total of 302 patients [median age: 86 years (IQR: 80–90), 22.2% female] were admitted to the Department of Geriatric Medicine were prospectively enrolled in this study. Frailty status was assessed using the Fried Frailty Phenotype (FFP), Clinical Frailty Scale (CFS), Frailty Index of Accumulative Deficits (FI-CD), and Short Physical Performance Battery (SPPB). Cox proportional hazard regression and Poisson regression were used to evaluating the association of the adverse outcomes with frailty as assessed using the four instruments. The discrimination accuracy of these tools in predicting the 1-year all-cause mortality was also compared.ResultsPrevalence of frailty ranged from 51% (using FFP) to 64.2% (using CFS). The four frail instruments were associated with 1-year mortality. After an average follow-up time of 2.18 years (IQR: 1.56–2.62 years), frailty as defined by four instruments (except for FI-CD), was associated with death [FFP: Hazard ratio (HR) = 3.11, 95% confidence interval (CI) 1.30–7.44; CFS: HR = 3.68, 95% CI 1.03–13.16; SPPB: HR = 3.74, 95% CI 1.39–10.06). Frailty was also associated with acute exacerbation (using FFP) and hospitalization (using FFP, CFS, and FI-CD). Frail showed a moderate predictive ability [area under the curve ranging (AUC) 0.70–0.80] and a high negative predictive value (0.98–0.99) for 1-year mortality.ConclusionsWith the four different frailty assessment tools, frailty was associated with poor prognosis in older patients with stable COPD. The FFP, CFS, FI-CD, and SPPB instruments showed similar performance in predicting 1-year mortality.

Highlights

Frailty is a distinct biologic syndrome characterized by decreasing physiologic reserve and increasing vulnerability to minor health stressors [1,2,3]
The research protocol was carried out according to the principles of the Helsinki Declaration and approved by the Research Ethics Committee of Beijing Friendship Hospital and Clinical frailty scale (CFS) The Clinical Frailty Scale (CFS) is a 9-point global assessment tool that summarizes the overall level of fitness or frailty of an older adult [12]
Baseline characteristics and frailty prevalence A total of 330 participants were included in this cohort

Summary

Introduction

Frailty is a distinct biologic syndrome characterized by decreasing physiologic reserve and increasing vulnerability to minor health stressors [1,2,3]. According to a recent review, the Fried Frailty Phenotype (FFP) and Frailty Index (FI) are the most commonly used tools for assessing frailty in patients with stable COPD in clinics and rehabilitation centers [7]. The Short Physical Performance Battery (SPPB) is a well-established tool for accessing the lower limb functional impairment in older adults, as a practical tool to assess mortality risk in patients with stable COPD [14,15,16,17]. The recent study suggested that SPPB correlates with two widely used models of the FFP and FI [18], and can be effective to identify frailty both by the phenotype and deficit accumulation models in geriatric outpatients [19]. We evaluated the ability of frailty measurements in predicting 1-year acute exacerbation, hospitalization, and mortality in older patients with COPD

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