Patient-Reported Outcomes Help to Uncover Frailty Patterns in Those With Acute COPD Exacerbations

Patient-reported outcomes (PROs) can help assess the extent of frailty in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), according to a study published in the International Journal of Chronic Obstructive Pulmonary Disease.

The researchers explained that frailty is a risk factor for AECOPD and is associated with worsening outcomes, like hospitalizations and mortality. They noted that assessing and improving the condition of frail individuals has become a “priority in public health” due to the increase in global aging and the lifespan of those with chronic diseases, like COPD.

Additionally, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends that patients with COPD use PROs to assess disease prognosis and severity. In particular, PROs can help patients identify AECOPD symptoms, like cough, dyspnea, and sputum production. PROs can also help patients describe how their symptoms impact their daily living activities, their health-related quality of life (HRQOL), and treatment effectiveness.

Despite AECOPD showing a strong association with both PROs and frailty, the relationship between PROs and frailty has not yet been established. Because past studies have shown mixed results, the researchers conducted a study to both explore the correlation of frailty status with disease characteristics and PROs in patients with AECOPD, as well as to determine the sensitivity and specificity of the modified COPD PRO scale (mCOPD-PRO) for detecting frailty.

COPD exacerbation | Image Credit: RFBSIP - stock.adobe.com

To do so, the researchers used data from the respiratory critical care unit of a large tertiary care institution in China between August 2022 and June 2023. From this, they recruited 315 eligible hospitalized patients with AECOPD. After excluding 13 patients with missing data, the researchers included 302 participants in their analysis.

The researchers noted that participants assessed frailty using the FRAIL scale, a self-report questionnaire with 5 components: fatigue, resistance, ambulation, illness, and loss of weight. They explained that patients scored each question either 0 or 1 depending on their response, with each total score ranging from 0 to 5. Patients with scores between 3 to 5 were categorized as frail, those with scores of either 1 or 2 were categorized as prefrail, and those with a score of 0 were categorized as robust.

Also, the mCOPD-PRO was used to assess the study population’s health status; it includes 27 items in the physiological, psychological, and environmental domains. The researchers noted that the PRO score, and scores for each dimension, varied between 0 and 4, with higher scores indicating poorer health status. Lastly, they collected various data about the patients, including their pulmonary function, age, sex, and residential status.

Of the 302 patients in the study population, 221 (73.2%) were male and there was a mean (SD) age of 72.4 (9.1) years. The researchers categorized 136 patients (45.0%) as frail, 123 patients (40.7%) as prefrail, and 43 patients (14.3%) as nonfrail.

Overall, the FRAIL scale was moderately correlated with the mCOPD-PRO scores (Spearman rank correlation coefficient [Rs], 0.52; P < .01) for all dimensions (Rs, 0.43-0.49; P < .01); the researchers found that m-COPD PRO had “good discriminate validity” for detecting frailty, with a specificity and sensitivity of 60.8% and 84.6%, respectively. They found that patients residing in rural areas (OR, 1.67; 95% CI, 1.01-2.76) and patients with higher mCOPD-PRO scores (OR, 4.78; 95% CI, 2.75-8.32) were more likely to be frail.

Conversely, physically active patients (OR, 0.42; 95% CI, 0.21-0.84) were less likely to be frail. Compared with nonfrail patients, the researchers found that those considered either frail or prefrail had a longer duration of illness, more severe dyspnea, poorer lung function, higher nutritional risk, greater requirement for domiciliary oxygen therapy, and increased rates of depression and anxiety.

The researchers acknowledged their study’s limitations, one being that the measures of PROs and frailty status involved subjective evaluations. Consequently, the gap between what was reported and what occurred may be biased. Also, since this was a cross-sectional study, causality for frailty could not be assessed. Based on the study’s findings and limitations, the researchers made suggestions for future research.

“Future studies could introduce objective evaluations, such as readmissions rates and mortality rates, to explore the consistency of these outcomes,” the authors concluded. “Further detailed investigations are expected to elucidate the relationship between frailty and COPD. Further evidence on the role of frailty prevention in improving the health status of patients can be gathered by investigating these limitations.”

Reference

Yang M, Liu Y, Zhao Y, Wang Z, He J, Wang Y, Anme T. Association of frailty with patient-report outcomes and major clinical determinants in patients with acute exacerbation of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2024;19:907-919.
doi:10.2147/COPD.S444580