Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Republic of Singapore.
Office of the Senior Deputy President & Provost, National University of Singapore, Singapore, Republic of Singapore.
Chest. 2022 May;161(5):1225-1238. doi: 10.1016/j.chest.2021.12.633. Epub 2021 Dec 13.
Physical frailty commonly is associated with COPD, and its evaluation in COPD may provide important prognostic information for risk stratification.
What are the comorbid associations of physical frailty with COPD? Does physical frailty singly and in combination with FEV percent predicted and dyspnea predict disability and mortality?
Prospective cohort study of community-dwelling adults 55 years of age or older in the Singapore Longitudinal Ageing Study. Baseline data of 1,162 participants with COPD and 3,465 participants without COPD included physical frailty, FEV percent predicted, and dyspnea. Outcome measures were prevalent and incident instrumental activities of daily living (IADL) and basic activities of daily living (ADL) disability at 3 to 5 years of follow-up and all-cause mortality up to 11 years. ORs, hazard ratios, and 95% CIs were adjusted for socioeconomic status, smoking, and comorbidity count.
Baseline prevalence of prefrailty (48.8%) and frailty (6.8%) in participants with COPD were significantly higher than in participants without COPD: frailty OR, 1.61; 95% CI, 1.15-2.26. Prefrailty or frailty was associated significantly with twofold increased odds of prevalent and incident IADL and basic ADL disability and mortality in participants with COPD. In combination with FEV percent predicted of < 80% or dyspnea, frailty was associated with substantially increased threefold to fourfold odds of prevalent and incident IADL and basic ADL disability, and twofold to threefold increased mortality hazard. A summary score combining physical frailty, FEV of < 80%, and dyspnea predicted steeper risk gradients of prevalent and incident IADL and basic ADL disability and mortality across four risk categories (0, 1, 2, 3-5), with the highest risk category predicting between sevenfold and 8.5-fold increased risks in crude analyses, which remained significantly high after covariate adjustment.
The study supports the use of physical frailty in addition to lung function and dyspnea in multidimensional evaluation of COPD.
身体虚弱通常与 COPD 相关，对 COPD 患者进行身体虚弱评估可为风险分层提供重要的预后信息。
身体虚弱与 COPD 的合并症有哪些关联？身体虚弱单独以及与 FEV%预计值和呼吸困难联合预测残疾和死亡率的情况如何？
对新加坡老龄化纵向研究中年龄在 55 岁及以上的社区居住成年人进行前瞻性队列研究。共纳入 1162 名 COPD 患者和 3465 名非 COPD 患者的基线数据，包括身体虚弱、FEV%预计值和呼吸困难。3 至 5 年随访时的主要结局为常见的和新发的工具性日常生活活动（IADL）和基本日常生活活动（ADL）残疾，11 年内的全因死亡率。调整了社会经济状况、吸烟和合并症数量后，采用比值比（OR）、风险比（HR）和 95%置信区间（CI）进行评估。
COPD 患者中衰弱前期（48.8%）和衰弱（6.8%）的基线患病率明显高于非 COPD 患者：衰弱的 OR 值为 1.61；95%CI，1.15-2.26。衰弱前期或衰弱与 COPD 患者常见的和新发的 IADL 和基本 ADL 残疾以及死亡率的两倍风险增加显著相关。与 FEV%预计值<80%或呼吸困难联合使用时，衰弱与常见的和新发的 IADL 和基本 ADL 残疾的三倍至四倍风险增加以及两倍至三倍的死亡率增加显著相关。一个结合身体虚弱、FEV<80%和呼吸困难的综合评分，可预测四个风险类别（0、1、2、3-5）中常见的和新发的 IADL 和基本 ADL 残疾以及死亡率的风险梯度更加陡峭，最高风险类别预测在未调整的分析中，风险增加 7 倍至 8.5 倍，调整后仍然显著较高。
该研究支持在 COPD 的多维评估中使用身体虚弱，除了肺功能和呼吸困难。
