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Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns

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Abstract

Background

Frailty associates with increased vulnerability to adverse health outcomes and reduced tolerance to medical interventions. Its impact on patients with chronic respiratory diseases, particularly beyond chronic obstructive pulmonary disease (COPD), remains poorly understood.

Aims

To evaluate the association between frailty index and 5-year mortality across different “spirometric” patterns and the variation in their occurring frailty determinants.

Methods

This study analyzed data from the SARA study, which enrolled 1968 older adults, to evaluate the association between frailty and 5-year mortality across different spirometric patterns. Frailty was assessed using the frailty index (FI), and spirometry was performed to determine lung function patterns. Hazard ratios (HRs) were calculated using Cox regression models, adjusting for age and sex.

Results

Among the study participants, 16% were classified as frail. Frailty was associated with a significantly increased risk of mortality across all spirometric patterns. The 5-year mortality rates were 34.3% in subjects with normal spirometry, 45.1% in those with obstructive defects, 55% in those with restrictive defects, and 42.6% in those with mixed airflow defects. The unadjusted HRs for mortality were 2.64 (95% CI 2.10–3.32) for the overall cohort, 2.24 (95% CI 1.48–3.40) for obstructive defects, 2.45 (95% CI 1.12–5.36) for restrictive defects, and 2.79 (95% CI 1.41–3.17) for mixed airflow defects. After adjusting for age and sex, the HRs remained statistically significant: 2.25 (95% CI 1.37–2.84) for the overall cohort, 2.08 (95% CI 1.37–3.18) for obstructive defects, 2.27 (95% CI 1.04–1.17) for restrictive defects, and 2.21 (95% CI 1.20–3.08) for mixed airflow defects.

Conclusion

Frailty is a common syndrome and is associated with a significantly increased risk of mortality. The FI provides valuable information for risk profiling and personalized interventions beyond age and lung function parameters. Including frailty assessment in clinical evaluations can aid in resource allocation and improve patient care in respiratory diseases.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, [SS]. The data are not publicly available due to italian law restrictions, since their containing information could compromise the privacy of research participants.

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Acknowledgements

Not applicable.

Funding

This study was not founded.

Author information

Authors and Affiliations

  1. Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy

    Simone Scarlata, Panaiotis Finamore & Raffaele Antonelli Incalzi

  2. Department of Medicine and Surgery, Internship Program in Geriatrics, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy

    Sonia Zotti

  3. Department of Physiotherapy, Monash University, Moorooduc Hwy, Frankston, Melbourne, VIC, 3199, Australia

    Christian R. Osadnik

  4. Monash Lung and Sleep Department, Monash Health, 246 Clayton Road, CLAYTON, Melbourne, VIC, 3168, Australia

    Christian R. Osadnik

  5. PROMISE Department, University of Palermo, Via del Vespro 133, 90127, Palermo, Italy

    Nicola Scichilone

  6. Operative Research Unit of Geriatrics, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy

    Pedone Claudio

  7. Department of Clinical Sciences and Community Health, University of Milan, Via della Commenda 19, 20122, Milano, Italy

    Matteo Cesari

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  1. Simone Scarlata
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Contributions

SS: conceptualization, methodology, data analysis, writing and editing original draft preparation. SZ: writing—original draft preparation. PF: writing—original draft preparation, CRO: writing—reviewing and editing, supervision. NS: development or design of methodology, provision of study materials. RAI: provision of study materials, supervision. CP: provision of study materials, supervision. MC: writing—reviewing and editing, supervision.

Corresponding author

Correspondence to Simone Scarlata.

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Conflict of interest

The authors declare no affiliations with or involvement in any organization or entity with any financial or nonfinancial interest related to this manuscript. They also deny any perceived or real conflict of interest related with the publication of the present scientific work.

Ethical approval and consent to participate

The study protocol has been complied in accordance the tenets of the Helsinki Declaration and has been approved by the Coordinating Centre Ethical Committee at the University of Palermo (Protocol Code: 3/276). A written informed consent was signed for inclusion prior to the start of the study from all subjects.

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The procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

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Scarlata, S., Zotti, S., Finamore, P. et al. Frailty in the chronic respiratory patient: association with mortality and clinical features in obstructive, restrictive, and mixed spirometric patterns. Aging Clin Exp Res 35, 2573–2581 (2023). https://doi.org/10.1007/s40520-023-02535-3

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