Association of Frailty with Patient-Report Outcomes and Major Clinical Determinants in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract

Purpose

This study aimed to explore the correlation of frailty status with disease characteristics and patient-reported outcomes (PROs) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and determine the sensitivity and specificity of modified COPD PRO scale (mCOPD-PRO) for detecting frailty.

Patients and Methods

This cross-sectional study surveyed 315 inpatients with AECOPD from a tertiary hospital in China from August 2022 to June 2023. Patient frailty and PROs were assessed using the validated FRAIL scale and mCOPD-PRO, respectively. Spearman’s ρ was used to assess the relevance of lung disease indicators commonly used in clinical practice, and ordinal logistic regression analyses were used to identify the variables associated with frailty status. The validity of mCOPD-PRO in discriminating frail or non-frail individuals was determined using the receiver operating characteristic curve.

Results

The participants (N=302, mean age 72.4±9.1 years) were predominantly males (73.2%). Among them, 43 (14.3%) patients were not frail, whereas 123 (40.7%) and 136 (45.0%) patients were pre-frail and frail, respectively. The FRAIL scale was moderately correlated with the mCOPD-PRO scores (Spearman’s rank correlation coefficient [Rs]=0.52, P<0.01) for all dimensions (Rs=0.43–0.49, P<0.01). Patients residing in rural areas (odds ratio [OR], 1.67; 95% confidence interval [95% CI], 1.01–2.76) and with higher mCOPD-PRO scores (OR, 4.78; 95% CI, 2.75–8.32) were more likely to be frail. Physically active patients (OR, 0.42; 95% CI, 0.21–0.84) were less likely to be frail. In addition, mCOPD-PRO had good discriminate validity for detecting frailty (area under the curve=0.78), with a sensitivity and specificity of 84.6% and 60.8%, respectively. The optimal probability threshold for mCOPD-PRO was ≥1.52 points.

Conclusion

In patients with AECOPD, frailty is closely related to PROs and disease characteristics. Additionally, the mCOPD-PRO score can distinguish well between frail and non-frail patients. Our findings provide support for interventions targeting frail populations with AECOPD.

Plain Language Summary

Patients with chronic obstructive pulmonary disease often have concomitant frailty that may lead to disease deterioration such as acute exacerbations, hospital readmissions, disability, and premature death. Patient-reported outcomes are often used in clinical practice to measure patients’ disease characteristics and overall status. Whether patients’ frailty state is associated with patient-reported outcomes and if so, which factors are associated with frailty remain unclear. This study, conducted in China, examined their relationship as well as identified factors associated with frailty states. 302 hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease completed a questionnaire answering questions about disease severity, frailty state, anxiety, and depression. The findings suggest that people who live in rural areas, self-reported more severe overall conditions, and are physically inactive are more likely to be frail. Patient-reported outcomes can distinguish between frail and non-frail patients. Therefore, patient-reported outcomes can be used to assess the extent of frailty; early screening of AECOPD combined frailty population and implementation of interventions can help mitigate the adverse effects of frailty.

Keywords:

• frailty
• COPD
• COPD exacerbation
• patient-report outcome
• aging

Abbreviations

COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; PROs, patient-reported outcomes; mCOPD-PRO, modified patient-reported outcome scale for chronic obstructive pulmonary disease; AECOPD, acute exacerbation of chronic pulmonary disease; NYHA, New York Heart Association; mMRC, modified Medical Research Council; CCI, Charlson Comorbidity Index; BMI, body mass index; CAT, COPD assessment test; NRS2022, Nutritional risk screening; ESPEN, European Society of Parenteral and Enteral Nutrition; HADS, Hospital Anxiety and Depression Scale; IQR, interquartile ranges; ROC, receiver operating curve; AUC, area under the curve; 95% CI, 95% confidence interval; SD, standard deviation; OR, odds ratio; IRR, incidence rate ratio; HRQoL, health-related quality of life; SGRQ, St. George’s Respiratory Questionnaire.

Data Sharing Statement

The datasets underlying this article are available from the corresponding author upon reasonable request.

Acknowledgments

We thank Prof. Jiansheng Li and his team for authorizing us to use the Modified Patient-Reported Outcome Scale (mCOPD-PRO).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no conflicts of interest to disclose in this work.

Additional information

Funding

This work was supported by the Funds for Cooperation Project of Nanchong City and North Sichuan Medical College, Grant No. 22SXQT0189, Nanchong Federation of Social Science Associations, Grant No. NC22B032, grant from China Scholarship Council, Grant No. 202208510018, and JST, the establishment of university fellowships towards the creation of science technology innovation, Grant No. JPMJFS2106.