Simone Scarlata1, Panaiotis Finamore2, Alice Laudisio2, Vittorio Cardaci3, Mattia Ramaccia2, Francesco D'Alessandro2, Claudio Pedone2, Raffaele Antonelli Incalzi2, Matteo Cesari4,5. 1. Internal Medicine and Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio Medico University and Teaching Hospital, Via Alvaro del Portillo, 200, Rome, Italy. scarlata.dott.simone@gmail.com. 2. Internal Medicine and Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio Medico University and Teaching Hospital, Via Alvaro del Portillo, 200, Rome, Italy. 3. Pulmonary Rehabilitation Unit, IRCCS San Raffaele Pisana Scientific Institute, Rome, Italy. 4. Geriatric Unit, Maugeri Clinical Research Institutes IRCCS, Milan, Italy. 5. Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Abstract
BACKGROUND: Airflow limitation alone is unable to capture the complexity of chronic obstructive pulmonary disease (COPD), better explained by comprehensive disease-specific indexes. Frailty is a clinical condition characterized by high vulnerability to internal and external stressors and represents a strong predictor of adverse outcomes. AIMS: Primary objective was to test the association between indexes of lung function and COPD severity with frailty index (FI), and secondary to evaluate the association between FI and comorbidities, cognitive and physical function, BODE index, and mortality. METHODS: 150 stable COPD outpatients were enrolled and followed up to 4 years. At baseline, participants performed a geriatric multidimensional assessment, pulmonary function tests, arterial blood gas analysis, 6-min walking test, and bioimpedance analysis. BODE and FI were calculated. Spearman's ρ was used to assess correlations. Mortality was assessed using Kaplan-Meier curves. RESULTS: Participants were followed up for a median of 39 months. Mean age was 73 years and median frailty index 0.15 (IQR 0.11-0.19). FI was higher in frequent exacerbators (≥ 2/year) (mean 0.18 vs 0.15, p 0.01) and dyspnoeic patients (mMRC ≥ 2) (mean 0.21 vs 0.14, p < 0.01) and correlated with lung volumes, expiratory flows, and pressure of arterial oxygen. FI was positively correlated with the number of comorbidities, depressive symptoms, cognitive decline, and BODE index. Mortality was higher in patients with BODE higher than 3 (HR 3.6, 95% CI 1.2-10.9), and not associated with FI. DISCUSSION: FI positively correlates with all clinical drivers orienting the choice of treatment in COPD. CONCLUSIONS: FI associates with lung function and COPD severity, but does not associate with mortality.
BACKGROUND: Airflow limitation alone is unable to capture the complexity of chronic obstructive pulmonary disease (COPD), better explained by comprehensive disease-specific indexes. Frailty is a clinical condition characterized by high vulnerability to internal and external stressors and represents a strong predictor of adverse outcomes. AIMS: Primary objective was to test the association between indexes of lung function and COPD severity with frailty index (FI), and secondary to evaluate the association between FI and comorbidities, cognitive and physical function, BODE index, and mortality. METHODS: 150 stable COPD outpatients were enrolled and followed up to 4 years. At baseline, participants performed a geriatric multidimensional assessment, pulmonary function tests, arterial blood gas analysis, 6-min walking test, and bioimpedance analysis. BODE and FI were calculated. Spearman's ρ was used to assess correlations. Mortality was assessed using Kaplan-Meier curves. RESULTS:Participants were followed up for a median of 39 months. Mean age was 73 years and median frailty index 0.15 (IQR 0.11-0.19). FI was higher in frequent exacerbators (≥ 2/year) (mean 0.18 vs 0.15, p 0.01) and dyspnoeic patients (mMRC ≥ 2) (mean 0.21 vs 0.14, p < 0.01) and correlated with lung volumes, expiratory flows, and pressure of arterial oxygen. FI was positively correlated with the number of comorbidities, depressive symptoms, cognitive decline, and BODE index. Mortality was higher in patients with BODE higher than 3 (HR 3.6, 95% CI 1.2-10.9), and not associated with FI. DISCUSSION: FI positively correlates with all clinical drivers orienting the choice of treatment in COPD. CONCLUSIONS: FI associates with lung function and COPD severity, but does not associate with mortality.
Authors: R Pellegrino; G Viegi; V Brusasco; R O Crapo; F Burgos; R Casaburi; A Coates; C P M van der Grinten; P Gustafsson; J Hankinson; R Jensen; D C Johnson; N MacIntyre; R McKay; M R Miller; D Navajas; O F Pedersen; J Wanger Journal: Eur Respir J Date: 2005-11 Impact factor: 16.671
Authors: J Wanger; J L Clausen; A Coates; O F Pedersen; V Brusasco; F Burgos; R Casaburi; R Crapo; P Enright; C P M van der Grinten; P Gustafsson; J Hankinson; R Jensen; D Johnson; N Macintyre; R McKay; M R Miller; D Navajas; R Pellegrino; G Viegi Journal: Eur Respir J Date: 2005-09 Impact factor: 16.671
Authors: M R Miller; J Hankinson; V Brusasco; F Burgos; R Casaburi; A Coates; R Crapo; P Enright; C P M van der Grinten; P Gustafsson; R Jensen; D C Johnson; N MacIntyre; R McKay; D Navajas; O F Pedersen; R Pellegrino; G Viegi; J Wanger Journal: Eur Respir J Date: 2005-08 Impact factor: 16.671
Authors: Sarah Houben-Wilke; Ingrid M Augustin; Jan H Vercoulen; Dirk van Ranst; Eline Bij de Vaate; Johan B Wempe; Martijn A Spruit; Emiel F M Wouters; Frits M E Franssen Journal: Eur Respir Rev Date: 2018-06-06
Authors: Ane Johannessen; Roy M Nilsen; Michael Storebø; Amund Gulsvik; Tomas Eagan; Per Bakke Journal: Am J Respir Crit Care Med Date: 2013-07-01 Impact factor: 21.405
Authors: Bartolome R Celli; Claudia G Cote; Jose M Marin; Ciro Casanova; Maria Montes de Oca; Reina A Mendez; Victor Pinto Plata; Howard J Cabral Journal: N Engl J Med Date: 2004-03-04 Impact factor: 91.245
Authors: Nichola S Gale; Ali M Albarrati; Margaret M Munnery; Ruth E Hubbard; Ruth Tal-Singer; John R Cockcroft; Dennis J Shale Journal: Chron Respir Dis Date: 2018-01-16 Impact factor: 2.444