{"title":"The impact of frailty on clinical outcomes among individuals with COPD: a systematic review and meta-analysis.","authors":"Mathew Cherian, Pourya Masoudian, Kednapa Thavorn, Jacqueline Sandoz, Risa Shorr, Sunita Mulpuru","doi":"10.1186/s12890-025-03595-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Frailty is a prevalent and robust predictor of poor outcomes for older adults and those with chronic disease. We performed a systematic review and meta-analysis of the literature to understand the association between frailty and clinical outcomes for people with COPD.</p><p><strong>Methods: </strong>We searched MEDLINE, EMBASE, Cochrane Central, CINAHL, and Web of Science from inception to February 2022, for observational studies evaluating the association between frailty and clinical outcomes among individuals with COPD. Included studies defined COPD by spirometry, used a validated frailty assessment tool, and compared dyspnea, symptom burden, health related quality of life, exacerbations, hospitalization, or mortality between frail and non-frail individuals. Risk of bias was assessed using the Newcastle Ottawa Scale. Mean differences or hazard ratios were calculated using inverse variance (IV) methods, odds ratios were calculated using Mantel-Haenszel methods, and homogeneity was assessed using I <sup>2</sup> statistics. Results were pooled using a random effects model.</p><p><strong>Results: </strong>Of 1385 identified studies, 16 studies were included with 7 studies included in the meta-analyses, representing 5903 individuals. The Fried Frailty Phenotype instrument was used in 50% of included studies. When comparing frail vs. non-frail people with COPD, pooled estimates revealed frail people with COPD had higher dyspnea scores [modified Medical Research Council (mMRC) score standardized mean difference (95% CI): 1.67 (1.40-1.92), I <sup>2</sup> = 24%]; higher symptom burden [COPD Assessment Test (CAT) score mean difference (95% CI): 10.24 (8.30-12.17), I <sup>2</sup> = 31%]; more COPD exacerbations in the prior year [mean difference (95% CI): 1.09 (0.62-1.56), I <sup>2</sup> = 0%), and increased odds of being hospitalized in the previous year [OR (95% CI): 2.94 (1.57-5.50); I <sup>2</sup> = 0%]. The largest study with longest follow up period showed increased mortality risk among frail vs. non-frail individuals with COPD, [HR (95% CI): 1.83 (1.24-2.68)].</p><p><strong>Conclusions: </strong>People with COPD and frailty experience increased dyspnea, symptom burden, exacerbation history, and hospitalizations compared to non-frail patients with COPD. Frailty is a robust predictor of outcomes among people with COPD and should be considered a treatable trait. Additional work is needed to standardize screening methods for frailty, and to understand the optimal timing of non-pharmacologic interventions to treat frailty among people with COPD.</p><p><strong>Prospero registry id: </strong>CRD42022329893.</p>","PeriodicalId":9148,"journal":{"name":"BMC Pulmonary Medicine","volume":"25 1","pages":"146"},"PeriodicalIF":2.6000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Pulmonary Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12890-025-03595-z","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Frailty is a prevalent and robust predictor of poor outcomes for older adults and those with chronic disease. We performed a systematic review and meta-analysis of the literature to understand the association between frailty and clinical outcomes for people with COPD.
Methods: We searched MEDLINE, EMBASE, Cochrane Central, CINAHL, and Web of Science from inception to February 2022, for observational studies evaluating the association between frailty and clinical outcomes among individuals with COPD. Included studies defined COPD by spirometry, used a validated frailty assessment tool, and compared dyspnea, symptom burden, health related quality of life, exacerbations, hospitalization, or mortality between frail and non-frail individuals. Risk of bias was assessed using the Newcastle Ottawa Scale. Mean differences or hazard ratios were calculated using inverse variance (IV) methods, odds ratios were calculated using Mantel-Haenszel methods, and homogeneity was assessed using I 2 statistics. Results were pooled using a random effects model.
Results: Of 1385 identified studies, 16 studies were included with 7 studies included in the meta-analyses, representing 5903 individuals. The Fried Frailty Phenotype instrument was used in 50% of included studies. When comparing frail vs. non-frail people with COPD, pooled estimates revealed frail people with COPD had higher dyspnea scores [modified Medical Research Council (mMRC) score standardized mean difference (95% CI): 1.67 (1.40-1.92), I 2 = 24%]; higher symptom burden [COPD Assessment Test (CAT) score mean difference (95% CI): 10.24 (8.30-12.17), I 2 = 31%]; more COPD exacerbations in the prior year [mean difference (95% CI): 1.09 (0.62-1.56), I 2 = 0%), and increased odds of being hospitalized in the previous year [OR (95% CI): 2.94 (1.57-5.50); I 2 = 0%]. The largest study with longest follow up period showed increased mortality risk among frail vs. non-frail individuals with COPD, [HR (95% CI): 1.83 (1.24-2.68)].
Conclusions: People with COPD and frailty experience increased dyspnea, symptom burden, exacerbation history, and hospitalizations compared to non-frail patients with COPD. Frailty is a robust predictor of outcomes among people with COPD and should be considered a treatable trait. Additional work is needed to standardize screening methods for frailty, and to understand the optimal timing of non-pharmacologic interventions to treat frailty among people with COPD.
期刊介绍:
BMC Pulmonary Medicine is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of pulmonary and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.