https://orcid.org/0009-0006-8053-5567
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Abstract
Background
Chronic obstructive pulmonary disease (COPD) is closely associated with frailty, and prevention of acute exacerbations is important for disease management. Moreover, COPD patients with frailty experience a higher risk of acute exacerbations. However, the frailty instruments that can better predict acute exacerbations remain unclear.
Purpose
(1) To explore the factors influencing frailty and acute exacerbations in stable COPD patients, and (2) quantify the ability of multidimensional frailty instruments to predict acute exacerbations within 1 year.
Patients and methods
In this retrospective longitudinal study, stable COPD patients were recruited from the outpatient department of Sichuan Provincial People’s Hospital from July 2022 to June 2023. COPD patients reviewed their frailty one year ago and their acute exacerbations within one year using face-to-face interviews with a self-developed frailty questionnaire. Frailty status was assessed using the Frailty Index (FI), frailty questionnaire (FRAIL), and Clinical Frailty Scale (CFS). One-way logistic regression was used to explore the factors influencing frailty and acute exacerbations. Multivariate logistic regression was used to establish a prediction model for acute exacerbations, and the accuracy of the three frailty instruments was compared by measuring the area under the receiver operating characteristic curve (AUC).
Results
A total of 120 individuals were included. Frailty incidence estimates using FI, FRAIL, and CFS were 23.3%, 11.7%, and 15.8%, respectively. The three frailty instruments showed consistency in COPD assessments (P<0.05). After adjusting for covariates, frailty reflected by the FI and CFS score remained an independent risk factor for acute exacerbations. The CFS score was the best predictor of acute exacerbations (AUC, 0.764 (0.663–0.866); sensitivity, 57.9%; specificity, 80.0%). Moreover, the combination of CFS plus FRAIL scores was a better predictor of acute exacerbations (AUC, 0.792 (0.693–0.891); sensitivity, 86.3%; specificity, 60.0%).
Conclusion
Multidimensional frailty assessments could improve the identification of COPD patients at high risk of acute exacerbations and facilitate targeted interventions to reduce acute exacerbations in these patients.
Abbreviations
FI, Frailty Index; FRAIL, Frailty Questionnaire; CFS, Clinical Frailty Scale; BMI, Body mass index; PEF, Peak expiratory flow; FEV1/FVC, Forced the first second of expiratory volume/forced vital capacity; CAT, COPD Assessment Test; mMRC, modified Medical Research Council scale; GOLD, Global Initiative for Chronic Obstructive Lung Disease; BD, Bronchodilator; LAMA, Long-acting muscarinic antagonists; LABA, Long-acting beta-antagonists; ICS, Inhaled corticosteroids; SD, Standard deviation; IQR, Interquartile range.
Data Sharing Statement
All the data used and/or analyzed during the current study are available from in the Sichuan Provincial Geriatric Medical Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China upon reasonable request.
Ethics Approval and Consent to Participate
The study protocol was approved by the Research Ethics Committee of Sichuan Academy of the Medical Sciences and Sichuan Provincial People’s Hospital (Lun Audit (Research) No. 52-1 of 2022). Informed consent was obtained from all the study participants before enrollment.
Consent for Publication
We have obtained consent for publication from all participants.
Acknowledgments
The Authors acknowledge the assistance of nurses in the geriatric intensive care unit of “Sichuan Provincial Geriatric Medical Center, Sichuan Provincial People’s Hospital” and the doctors and nurses of Shuangliu district Maoyuan Hospital for their great efforts and help for data collection. We thank all the participants of this study for their willingness to take part in our research.
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. All authors had drafted or written, or substantially revised or critically reviewed the article. All authors had agreed on the journal to which the article will be submitted. All authors reviewed and agreed on all versions of the article before submission, during revision, the final version accepted for publication, and any significant changes introduced at the proofing stage. All authors agreed to take responsibility and be accountable for the contents of the article.
Disclosure
The authors report no conflicts of interest in this work.