PREVALENCE OF FRAILTY IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. A PILOT STUDY

Abstract

Abstract Frailty is a multidimensional syndrome that leads to greater vulnerability to stress, increasing the risk of adverse health outcomes. It is a dynamic process, with transitions between being robust, pre-fragile and fragile over time, suggesting that it is modifiable. Inflammatory bowel disease (IBD) results in altered immune function with amplified inflammation. When severe, it manifests with features associated with frailty, such as weight loss, fatigue, and sarcopenia. The first studies on frailty in IBD were carried out in a surgical context. Subsequent studies have associated frailty with increased risk of mortality as an independent factor in IBD patients. Of the available evidence, all are retrospective -except one- and the majority measures frailty with associated ICD-10 diagnoses, which can underestimate its prevalence in younger patients. There is no consensus in the literature on the best tool to measure frailty, however, this pilot study will objectively evaluate, using a risk score, the prevalence of this syndrome, which will allow, in the future, to carry out prospective studies that characterize frailty in IBD, understand the dynamic and longitudinal relationship between frailty and disease activity and, if appropriate, design and test interventions to alleviate this syndrome and its consequences in this population. This was a descriptive study, with the objective to determine the prevalence of frailty in IBD patients in a teaching hospital in Chile. We also compared the characteristics of frail vs non-frail IBD patients. Frailty was measured using SHARE-FI tool, which is a validated score to measure frailty in primary care, even in patients under 65 years of age. 64 patients were recruited, 28 had ulcerative colitis, 33 had Crohn’s disease and 3 had indeterminate colitis. 62.5% were female, with an average age of 42,3 ± 13,65 years. Average years since diagnosis were 11,6 ± 9,89. The prevalence of frailty was 40,62%. No association was observed between the presence of frailty and the type of IBD, IBD activity indices, use of corticosteroids, use of biologic therapy, surgeries associated with IBD, IBD flare-ups with hospitalization within the last year, calprotectin levels, vitamin D levels. The odds of the presence of frailty in women are 4,2 times greater than in men, being women a possible risk factor for frailty. The frailty group had worse quality life measured with the IBD Questionnaire 9 (OR 0,86 [IC95% 0,79-0,94). In conclusion, the prevalence of frailty in IBD was 40,62%. Contrary to what might be assumed, frailty turned out to be a condition independent of the type of IBD, time of evolution, activity and treatment, mostly associated with female sex and a worse quality of life. New studies are required to determine factors predisposing to frailty in IBD patients and prevent its appearance in order to improve their prognosis.