Association of physical frailty with incidence and life expectancy of chronic obstructive pulmonary disease: a population-based cohort study.

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE

Chest Pub Date : 2025-04-19 DOI:10.1016/j.chest.2025.03.032

Chao Liu,Hui Xiong,Xia Han,Yanling Lv,Decai Wang,Jiannan Hu,Ziling Li,Xinyue Ma,Yunfei Zhu,Shuyun Xu,Liangkai Chen

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Abstract

BACKGROUND The bidirectional relationship between frailty and chronic obstructive pulmonary disease (COPD) is documented. However, longitudinal studies examining the combined effects of genetic predisposition and preserved ratio impaired spirometry (PRISm) on frailty in COPD development are lacking. RESEARCH QUESTION What is the association between physical frailty and the incidence and mortality of COPD, and how do genetic predisposition and PRISm modify this association? STUDY DESIGN AND METHODS We included 412,351 adults without COPD (mean age 56.1±8.1 years, 44.3% male) and 60,584 COPD patients (mean age 59.2±7.4 years, 55.1% male) at baseline in the UK Biobank cohort. Frailty phenotypes were assessed using five components, including weight loss, exhaustion, low physical activity, slow gait speed, and low grip strength. Cox proportional hazards regression models were employed to evaluate the association of genetic predisposition, PRISm, and frailty with COPD development. Life expectancy reductions due to frailty were estimated using life table methods in COPD patients. RESULTS During a median follow-up of 13.5 years, 10,695 incident COPD cases were recorded. In the multivariable-adjusted model, frailty and prefrailty were significantly associated with an increased risk of COPD (HR 2.21, 95% CI: 2.06-2.37 for frailty; HR 1.45, 95% CI: 1.39-1.51 for prefrailty). Significant interactions were observed between genetic predisposition and frailty (Pinteraction=0.0252), as well as between PRISm and frailty (Pinteraction=0.0027), in the development of COPD. Among patients with COPD at age 45, frailty was associated with a reduction in life expectancy of 8.49 years for males and 7.67 years for females, while prefrailty was associated with reductions of 3.27 and 2.78 years, respectively, compared to their non-frail counterparts. INTERPRETATION Frailty and prefrailty increase COPD risk and are linked to reduced life expectancy in patients with COPD, highlighting the need for early detection and management of frailty in COPD prevention and treatment strategies.

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身体虚弱与慢性阻塞性肺疾病发病率和预期寿命的关系：一项基于人群的队列研究

背景虚弱与慢性阻塞性肺疾病（COPD）之间的双向关系已被证实。研究问题身体虚弱与慢性阻塞性肺病的发病率和死亡率之间有什么关系，遗传易感性和 PRISm 如何改变这种关系？研究设计与方法我们纳入了英国生物库队列中基线的 412,351 名未患慢性阻塞性肺病的成年人（平均年龄为 56.1±8.1岁，44.3% 为男性）和 60,584 名慢性阻塞性肺病患者（平均年龄为 59.2±7.4岁，55.1% 为男性）。评估虚弱表型时使用了五个组成部分，包括体重减轻、疲惫、体力活动少、步态速度慢和握力弱。采用 Cox 比例危险回归模型评估遗传易感性、PRISm 和虚弱与慢性阻塞性肺病发展的关系。结果在中位 13.5 年的随访期间，共记录了 10,695 例慢性阻塞性肺病病例。在多变量调整模型中，虚弱和体弱前期与慢性阻塞性肺病发病风险的增加显著相关（虚弱的 HR 为 2.21，95% CI 为 2.06-2.37；体弱前期的 HR 为 1.45，95% CI 为 1.39-1.51）。在慢性阻塞性肺病的发病过程中，遗传易感性与虚弱之间（Pinteraction=0.0252）以及 PRISm 与虚弱之间（Pinteraction=0.0027）存在显著的交互作用。在 45 岁的慢性阻塞性肺病患者中，与不虚弱的同龄人相比，男性虚弱与预期寿命减少 8.49 年有关，女性虚弱与预期寿命减少 7.67 年有关，而前期虚弱与预期寿命减少 3.27 年和 2.78 年有关。

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.