Frailty on in-hospital death in older patients with acute exacerbation of chronic obstructive pulmonary disease: a real-world prospective cohort study

Few evidence exists for the effect of frailty on patients admitted with an acute exacerbation of chronic obstructive pulmonary disease(AECOPD). We explored the link of frailty and in-hospital death, and whether laboratory indicators mediate this association. A real-world prospective cohort study included older AECOPD patients in two cohorts: a training set(n=1356) and a validation set(n=478). Independent factors, including frailty, were identified by logistic regression. The relationship between frailty and in-hospital mortality was assessed by Cox regression. A clinician-focused nomogram for in-hospital death risk and mediation analyses for frailty and death were conducted. The training set included 1356 patients(aged 86.7±6.6), and 25.0% of them were frail. A nomogram model incorporated ten independent variables: age, sex, frailty, mean arterial pressure, Charlson comorbidity index, neutrophil–lymphocyte ratio, Interleukin-6, c-reactive protein, albumin, and troponin T. The area under the receiver operating characteristic curve was 0.839 and 0.837 for the training set and validation set, respectively. Patients with frailty were associated with in-hospital death(HR, 1.65, 95%CI: 1.07-2.53; p=0.023). Frailty in older AECOPD patients may predict adverse outcomes, with CRP and albumin potentially serving as mediators in the frailty-to-in-hospital death mechanism. <fig><object-id>erj;64/suppl_68/PA2951/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>