Evaluation and impact of frailty in patients with acute exacerbations of COPD.

Abstract

Introduction: Frailty is a clinically important, treatable trait that rarely features in Australian respiratory care models for patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). This study evaluated the prevalence of frailty in patients with AECOPD and its clinical relevance. Method(s): 74 patients with AECOPD (mean FEV1 47.5%, age 72years, BMI 27) were assessed within 48 hours of admission according to the Fried phenotype and Short Performance Physical Battery (SPPB), and a status of 'frail' or 'not frail' determined. Frailty prevalence was compared between instruments and associations between frailty and clinical outcomes explored via t tests, univariate logistic regression and Kaplan- Meier survival curves. Result(s): Frailty was detected in 48% (Fried) and 18% (SPPB) of patients. Compared to those who were not frail, frailty associated with increased age and falls history, decreased muscle force, gait speed and 6-minute walk distance (P<0.01 for all) and an approx. 3-fold increased risk of 90-day re-admission / mortality (P = 0.051). Conclusion(s): Frailty is common amongst patients with AECOPD and associates with poor clinical outcomes. This subgroup may require additional supportive care strategies after hospital discharge.