The Clinical Characteristic and Prognostic Value of Frailty in Elderly COPD Patients

Frailty, as one of the extrapulmonary comorbidities of chronic obstructive pulmonary disease (COPD), is highly prevalent in COPD patients. The primary objective of this research was to assess how frailty influences subsequent exacerbation and augments the predictive capacity of dyspnoea or the exacerbation history among elderly COPD patients.

The elderly COPD patients in this study were registered in the RealDTC study from June 2023 to March 2024. The Fried frailty phenotype was used to evaluate frailty, and patients were classified as robust, pre-frail or frail. A Modified Medical Research Council Dyspnea Scale (mMRC) score of ≥ 2 was defined as more dyspnoea. For a risk index involved with frailty, dyspnoea and the exacerbation history, different scores were assigned to each factor. After 1 year of follow-up, moderate to severe exacerbations and all-cause mortality were recorded.

In total, 466 elderly patients were enrolled. Their mean age was 71.2 ± 4.5 years, with 89.0% male and 79.0% smokers. The mean COPD Assessment Test (CAT) score and forced expiratory volume in 1 s (FEV₁)/forced vital capacity (FVC) were 14.1 ± 6.5 and 50.2 ± 11.6, respectively. Among all patients, 255 (54.7%) were in pre-frailty and 132 (28.3%) were in frailty. Age (odds ratio [OR] = 1.135, 95% confidence interval [95%CI] = 1.060-1.216) and dyspnoea (OR = 3.654, 95%CI = 2.106-6.340) were correlated with pre-frailty, and age (OR = 1.269, 95%CI = 1.120-1.438), dyspnoea (OR = 37.959, 95%CI = 12.694-113.503), educational level (OR = 0.303, 95%CI = 0.111-0.829), FEV₁% predicted (OR = 0.976, 95%CI = 0.955-0.998) and BMI (OR = 0.845, 95%CI = 0.753-0.948) were independently associated with frailty in elderly COPD patients (all p < 0.05). The elderly COPD patients with pre-frailty (OR = 2.182, 95% CI = 1.081-4.405) or frailty (OR = 3.377, 95%CI = 1.614-7.063) had an increased risk for future frequent exacerbation. Regarding all-cause mortality, frailty has less effect on it in the 1-year follow-up of elderly COPD patients. By the ROC curve, frailty has the capacity (area under curve [AUC] = 0.607) to predict future exacerbation in elderly COPD patients. The combination of frailty and dyspnoea or the exacerbation history exhibited better predictive abilities than dyspnoea or the exacerbation history alone for future exacerbation, respectively (all p < 0.05).

Frail elderly COPD patients present older age, lower BMI, poorer educational level, heavier symptom burden and worse pulmonary function. As a key COPD comorbidity, frailty increases the risk of future exacerbation, and combining it with dyspnoea or exacerbation history improves the predictive value for subsequent exacerbation.