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Frailty and Clinical Outcomes in Chronic Obstructive Pulmonary Disease
Journal article   Open access   Peer reviewed

Frailty and Clinical Outcomes in Chronic Obstructive Pulmonary Disease

Cassie C Kennedy, Paul J Novotny, Nathan K LeBrasseur, Robert A Wise, Frank C Sciurba, Roberto P Benzo and NETT Research Group
Annals of the American Thoracic Society, Vol.16(2), pp.217-224
02/2019
DOI: 10.1513/AnnalsATS.201803-175OC
PMCID: PMC6376949
PMID: 30433830
url
https://doi.org/10.1513/AnnalsATS.201803-175OCView
Published (Version of record) Open Access

Abstract

Frailty represents an increased vulnerability to adverse health outcomes. The frailty phenotype conceptual model (three or more patient attributes of wasting, exhaustion, low activity, slowness, and weakness) is associated with increased morbidity and mortality in geriatric populations. Our objective was to describe the risks associated with frailty in patients with chronic obstructive pulmonary disease. Data from the National Emphysema Treatment Trial (NETT) were retrospectively analyzed. The frailty phenotype conceptual model was operationalized as three or more frailty parameters (a body mass index decrease of ≥5% over 12 months, self-reported exhaustion, low 6-minute walk distance, or physical activity or respiratory muscle strength in the lowest quartile). Frail participants were compared with participants with two or fewer frailty parameters. Participants were followed starting 12 months after NETT randomization (to minimize surgical effect) for 24 months. Univariate, multivariate, Kaplan-Meier, and Cox proportional hazard analyses were performed, adjusting for treatment arm, age, modified Medical Research Council dyspnea scale, sex, and baseline forced expiratory volume in 1 second (FEV ). Multiple imputation was used for missing values. The participants (N = 902) were predominantly white (94.5%) males (59.5%), with a median age of 67 years (interquartile range, 63-70 yr) and a median FEV % predicted of 26 (interquartile range, 20-33). Six percent of the participants (95% confidence interval [CI], 4.5 to 7.6) were frail. The incidence rate of frailty was 6.4 per 100 person-years. Frail participants reported significantly worse disease-specific and overall quality of life by St. George's Respiratory Questionnaire total score (mean difference of 11.6; 95% CI, 7.6 to 15.6; P < 0.001), mental composite on Medical Outcomes Survey Short Form-36 (mean difference -6.8; 95% CI, -10.0 to -3.6; P < 0.001), and physical composite scores on Medical Outcomes Survey Short Form-36 (mean difference -16.7; 95% CI, -21.3 to -12.1; P = 0.001). Frail participants had an increased rate of hospitalization (adjusted hazard ratio, 1.6; 95% CI, 1.1 to 2.5; P = 0.02) and an adjusted increase in hospital use of 8.0 days (95% CI, 4.4 to 11.6; P < 0.001) compared with nonfrail participants. Frail participants had a higher mortality rate (adjusted hazard ratio, 1.4; 95% CI, 0.97 to 2.0; P = 0.07). Among adults with chronic obstructive pulmonary disease, our measure of frailty (modified from the Fried frailty phenotype) was associated with incident and longer-duration hospitalization, and with poor quality of life.
 Quality of Life Aged Female Forced Expiratory Volume Frail Elderly - statistics & numerical data Hospitalization - statistics & numerical data Humans Male Middle Aged Pulmonary Disease, Chronic Obstructive - mortality Pulmonary Disease, Chronic Obstructive - physiopathology Retrospective Studies Surveys and Questionnaires Survival Analysis United States - epidemiology Walk Test

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