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Comparative Study
. 2024 May 24:19:1131-1139.
doi: 10.2147/COPD.S455316. eCollection 2024.

Frailty and Exacerbation of Chronic Obstructive Pulmonary Disease: Is There Any Association?

Koichi Nishimura  1   2 , Masaaki Kusunose  3 , Ryo Sanda  3 , Ayumi Shibayama  4 , Kazuhito Nakayasu  5
Affiliations
Comparative Study

Frailty and Exacerbation of Chronic Obstructive Pulmonary Disease: Is There Any Association?

Koichi Nishimura et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: This study investigated if individuals with chronic obstructive pulmonary disease (COPD) and frailty are more likely to have acute exacerbations of COPD or require hospitalization for exacerbation than those without frailty.

Patients and methods: Data on 135 outpatients with stable COPD were analyzed with the Cox proportional hazards model to assess the risk of future events. The Kihon Checklist was administered at baseline to classify the participants as robust, pre-frail, or frail. The follow-up period was a maximum of six and a half years.

Results: In all, 76 patients (56.3%) experienced an exacerbation and 46 (34.1%) were hospitalized due to it. Multivariate Cox proportional hazards analysis that accounted for FEV1 and sex showed that the frail group was more likely to face future risks of COPD exacerbations [Hazard ratio 1.762 (95% CI 1.011-3.070), p=0.046] and hospitalizations for exacerbation [2.238 (1.073-4.667), p=0.032] than the robust group. No significant differences were observed when comparing robust patients to those who were pre-frail or pre-frail to frail either in exacerbations or hospitalizations. When comparing the C-indices for frailty and FEV1, the former index (exacerbation 0.591 and hospitalization 0.663) did not exceed the latter (0.663 and 0.769) in either analysis.

Conclusion: Frail COPD patients have a more unfavorable future risk of acute exacerbations of COPD and hospitalizations for exacerbation than robust patients. However, no significant differences were observed when comparing robust patients to those who were pre-frail or pre-frail to frail, suggesting that the future risk for COPD patients with frailty is only higher compared to those who are considered robust. Additionally, FEV1 was found to be a more reliable predictor of future events than measures of frailty.

Keywords: COPD; Kihon Checklist; acute exacerbations of COPD; future risk; hospitalization.

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Conflict of interest statement

The authors declare that they have no competing interests in this work.

Figures

Figure 1
Figure 1
Kaplan–Meier curves of cumulative incidence of acute exacerbation of COPD based on three strata (frail, pre-frail and robust) defined by the Kihon Checklist Total score.
Figure 2
Figure 2
Kaplan–Meier curves of cumulative incidence of hospitalization due to exacerbation of COPD based on three strata (frail, pre-frail and robust) defined by the Kihon Checklist Total score.
See this image and copyright information in PMC

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