Frailty Assessment in a Stable COPD Cohort: Is There a COPD-Frail Phenotype?

Naval, Elsa; González, Maria Cruz; Giraldós, Sonia; Calatayud, Julia; Jornet, Marc; Lluch, Inmaculada; Meseguer, M. Rosario Noguero; Cubillán, Juan José Ruíz; Viña, José; Tarazona-Santabalbina, Francisco José

doi:10.1080/15412555.2021.1975670

Cited by 22 publications

(44 citation statements)

References 28 publications

(42 reference statements)

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“…Data from 10 studies [ 11 , 22 – 24 , 26 , 27 , 29 , 32 , 33 , 35 ] involving 2,392 participants were available for meta-analysis of CAT score, showing that those with frailty presented higher CAT score than those without frailty [mean difference 6.20(95%CI 4.43 to 7.96); I 2 = 84.95%, Fig. 3 B].…”

Section: Resultsmentioning

confidence: 99%

Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis

2023

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Background Frailty has been increasingly identified as a risk factor of adverse outcomes in chronic obstructive pulmonary disease (COPD). The prevalence and impact of frailty on health outcomes in people with COPD require clarification. Methods PubMed, Embase, The Cochrane Library and Web of Science (January 1, 2002, to July 1, 2022) were comprehensively searched to identify studies related to frailty and COPD. Comparisons were made between people who did and did not have frailty for pulmonary function, dyspnea severity, 6-minute walking distance, activities of daily life, and mortality. Results Twenty studies (9 cross-sectional, 10 cohort studies,1 clinical trial) from Europe (9), Asia (6), and North and South America (4), Oceania (1) involving 11, 620 participants were included. The prevalence of frailty was 32.07% (95% confidence interval (CI) 26.64–37.49) with a range of 6.43–71.70% based on the frailty tool used. People with frailty had lower predicted forced expiratory volume in the first second (mean difference − 5.06%; 95%CI -6.70 to -3.42%), shorter 6-minute walking distance (mean difference − 90.23 m; 95%CI -124.70 to -55.76), poorer activities of daily life (standardized mean difference − 0.99; 95%CI -1.35 to -0.62), higher CAT(COPD Assessment Test) score(mean difference 6.2; 95%CI 4.43 to 7.96) and mMRC (modified Medical Research Council) grade (mean difference 0.93; 95%CI 0.85 to 1.02) compared with those who did not (P < 0.001 for all). Meta-analysis showed that frailty was associated with an increased risk of long-term all-cause mortality (HR 1.68; 95% CI 1.37–2.05; I2 = 0%, P < 0.001). Conclusion Frailty is prevalent in people with COPD and linked with negative clinical outcomes including pulmonary function, dyspnea severity, exercise capacity, quality of life and mortality.

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Section: Resultsmentioning

confidence: 99%

Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis

2023

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“…In a cohort of individuals (age ≥40) with stable COPD, Naval et al found approximately 40% of individuals identified as frail using the Fried phenotype also had more severe BODE scores. 61 Using a deficit accumulation definition of frailty, Scarlata et al showed a strong correlation ( r =0.53) between frailty and BODE scores among stable COPD patients age 60 or older. 62 …”

Section: Discussionmentioning

confidence: 99%

Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes

Roberts¹,

Mapel²,

Ganvir³

et al. 2022

COPD

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Rationale Frailty prevalence estimates among individuals with COPD have varied widely, and few studies have investigated relationships between frailty and adverse outcomes in a COPD population. Objective(s) Describe frailty prevalence among individuals with and without COPD and examine associations between frailty and mortality and other adverse outcomes in the next two years. Methods This was an observational cohort study using Health and Retirement Study data (2006–2018) of community living individuals ages 50–64 and ≥65 with and without COPD (non-COPD). Frailty (Fried phenotype [5 items], and a modified Frailty Index-Comprehensive Geriatric Assessment [Enhanced FI-CGA] [37 items], and debility (modified BODE Index [4 items]) were assessed. Two-year post-assessment outcomes (mortality, ≥1 inpatient stay, home health and skilled nursing facility (SNF) use) were reviewed in a population matched 3:1 (non-COPD: COPD) on age, sex, race, and year using univariate and multivariate logistic regression (adjusted for morbidities). Area-under-the-curve (AUC) was used to evaluate regressions. Results The study included 18,979 survey observations for age 50–64, and 24,162 age ≥65; 7.8% and 12.0% respectively reporting a diagnosis of COPD. Fried phenotype frailty prevalence for age ≥65 was 23.1% (COPD) and 9.4% (non-COPD), and for the Enhanced FI-CGA, 45.9% (COPD) and 22.4% (non-COPD). Two-year mortality for COPD was more than double non-COPD for age 50–64 (95% CI: 3.8–5.9% vs 0.7–1.3%) and age ≥65 (95% CI: 11.9–14.3% vs 5.6–6.6%). Inpatient utilization, home health care use, or at least temporary SNF placement were also more frequent for COPD. Measures were predictive of adverse outcomes. In adjusted models, the Fried phenotype and modified BODE score performed similarly, and both performed better than the Enhanced FI-CGA index. AUC values were higher for morality regressions. Conclusion Frailty prevalence among individuals with COPD in this national survey is substantially greater than without COPD, even at pre-retirement (50–64 years). These measures identify patients with increased risk of poor outcomes.

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“…34 In addition, previous studies have shown that pre-frail and non-frail patients have different physical activity, and may play a significant role in morbidity and mortality. 12,13,[35][36][37] In particular, a poor performance in the 5-STS has been shown to be a predictor of re-hospitalization 31 and survival in COPD patients. 35 However, hypotheses about timing and length of stay remained to be confirmed.…”

Section: Discussionmentioning

confidence: 99%

The prognosis of pre-frail chronic obstructive pulmonary disease patients for hospitalizations and mortality depends on their level of functional physical performance

et al. 2022

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Objective To determine if pre-frail Chronic obstructive pulmonary disease (COPD) patients with poor and non-poor performance in the five-repetition sit-to-stand test (5-STS) had a worse prognosis for hospitalization and mortality at 2 years and for mortality at 5 years than non-frail patients. Methods We prospectively included patients with stable COPD, between 40 and 80 years, from a hospital in Spain. Patients were classified according their performance on the 5-STS test and level of frailty. Timing, number of hospitalizations, length of stay, and timing and rate of mortality were outcome measures. Patients were followed for 2 years for exacerbations and for 5 years for mortality. Kaplan-Meier curves and univariate and multivariate Cox proportional-hazard analyses, ANOVA tests and univariate and multivariate linear and logistic regression models were used. Results Of the 125 patients included, 25.6% were pre-frail with poor performance, 57% pre-frail with non-poor performance, and 17.4% non-frail with non-poor performance. Pre-frail patients with poor performance had a higher number of hospitalizations (adjusted beta: 0.49; 95% CI: 0.01–0.96), mortality rates (odds ratio: 11.33; 95% CI: 1.15–110.81), and risk at 5 years (adjusted hazard ratio: 8.77; 95% CI: 1.02–75.51) than non-frail patients. Pre-frail patients with poor performance also had worse prognoses than non-frail patients with respect to length of hospital stays (increased by 4.16 days) and timing to first hospitalization (HR: 6.01) in unadjusted models, but not when adjusted. Conclusion The COPD prognosis of pre-frail patients with respect to the number of exacerbations with hospitalization and the timing and rate of mortality is dependent of functional performance.

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Frailty Assessment in a Stable COPD Cohort: Is There a COPD-Frail Phenotype?

Cited by 22 publications

References 28 publications

Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis

Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis

Frailty Among Older Individuals with and without COPD: A Cohort Study of Prevalence and Association with Adverse Outcomes

The prognosis of pre-frail chronic obstructive pulmonary disease patients for hospitalizations and mortality depends on their level of functional physical performance

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