S0671 The Association of Frailty With Mortality and Relapse Frequency in Inflammatory Bowel Disease

Abstract

INTRODUCTION: Frailty represents a state of diminished physiologic reserve. While the influence of frailty on gut immune response, inflame-aging and microbiome composition is subject to ongoing investigation, limited data exists on clinical outcomes in frail inflammatory bowel disease (IBD) patients. We tested the hypothesis that a modified frailty index will predict mortality and propensity for more frequent flares of inflammatory bowel disease. METHODs: An observational analysis of a retrospectively collected data from a single center in patients with Ulcerative Colitis and Crohn's disease was performed. Study period was 2008–2019. A 7 factor IBD frailty index was modified from the Canadian Study of Health and Aging Frailty Index. For each patient a frailty score and a frailty index were calculated. A frailty index of >0.27 was used to define a frailty. Multivariate logistic regression analyses were conducted to assess the probability of mortality and >5 IBD flares in frail and non-frail patients, while controlling for potential comorbid confounders. The calibration of logistic models was tested via Hosmer-Lemeshow test; predictive capacity was assessed via a c-statistic obtained from receiver operating curves. RESULTS: A total of 2978 patients were included; 53.5% with Ulcerative colitis, 0.5% with indeterminate colitis and the rest with Crohn's. The prevalence of frailty was 32% in this population of patients with IBD. Frail patients with IBD were more frequently older, female, had a higher mean BMI and were more often smokers (P < 0.001 for all via two-tailed t-tests and chi-square analysis). The prevalence of mortality in frail patients was statistically higher than the mortality prevalence in the non-frail (11.42% vs 3.75%, P < 0.01). Similarly, a higher proportion of frail patients experienced >5 IBD flares than non-frail patients (35.6% vs 27.5%, P < 0.001) through the study period. On regression analysis (Figure 1), frailty was associated with highest odds for mortality in patients with IBD (odds ratio 1.52, confidence interval 1.07–2.16, P = 0.01). Frail status did not predict the odds of having >5 IBD relapses as compared to non-frail patients (odds ratio 1.20, confidence interval 0.99–1.45, P = 0.05). CONCLUSION: This study provides the first evidence of an association between frailty and mortality in patients with inflammatory bowel disease. Potential areas of further investigation include phenotypic assessments of frailty, rather than an index approach utilized herein, in patients with IBD.Figure 1.: The Impact of Frailty on IBD Mortality.Figure 2.: The Impact of Frailty on IBD Flare Frequency.