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Frailty in COPD hospitalized patients: Associated factors from a multicentre cohort study
Cristóbal Esteban1, María Gascón2, Eva Tabernero3
1Respiratory Department, Hospital Galdakao, Galdakao, Bizkaia, Spain; BioBizkaia Health Research Institute, Barakaldo, Spain; Health Services Research on Chronic Patients Network (REDISSEC), Spain; Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Spain.
Objective:
The aim of the study was to determine the association between frailty and hospitalizations, mid-term mortality and medical readmissions, and to evaluate the relationship between frailty and other variables, such as dependence, anxiety, depression and health-related quality of life in a cohort of COPD patients after admission due to exacerbation (eCOPD).
Methods:
Prospective observational cohort study conducted across nine Spanish hospitals. Patients were recruited consecutively. Variables relating to the patients' clinical baseline status were recorded, including the Tilburg Frailty Indicator (TFI), EuroQol EQ-5D, the COPD Assessment Test (CAT), Yale Physical Activity Survey (YPAS); the mMRC Dyspnea Scale, Hospital Anxiety and Depression Scale (HAD), and the Duke-UNC scale.
Results:
1638 COPD patients were studied, with a mean age of 72.4 (SD 10.3), 77 % male, mean FEV1 49.4 % (SD 19.2), median Charlson index 2; mean CAT 21.3 (SD 9.1). In the multivariate analysis, the variables independently associated with frailty were older age, female sex, comorbidities, health-related quality of life, dyspnea, dependence, anxiety, depression, and physical activity. Multivariable survival regression analysis identified TFI, sex, and previous hospitalizations as predictors of one-year mortality. These variables, together with comorbidities, were associated with the risk of readmission due to any medical condition during the 1-year follow-up.
Conclusions:
Frailty was associated with admission due to eCOPD and to the number of hospitalizations. In COPD, a single hospitalization should be considered a warning sign for frailty. Variables such as dependence, anxiety, depression and HRQoL were independent predictors of frailty. Additionally, frailty was associated with mortality and medical readmissions in the following year.
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