Developmental trajectories of frailty among Chinese elderly COPD patients: a prospective cohort study

BACKGROUND: The trajectory of frailty in patients with COPD and its predictors have yet to be determined. Therefore, this study aims to explore the development trajectory and predictors of frailty in patients with COPD. METHODS: This study is a prospective cohort study, ultimately including 378 participants. Among the 378 enrolled participants, 307 (81.2%) were male, with a mean age of 73 ± 8 years. Based on GOLD Classification, patients were distributed as follows: Group A (n = 104), Group B (n = 155), and Groups C/D (n = 119) .The Frailty Phenotypic Assessment Scale was employed to measure the frailty status of patients at admission, as well as at 1,6 and 12 months post-admission. Group-based trajectory modeling was utilized to analyze the frailty trajectories of COPD patients, and further analysis was conducted to identify the factors influencing these frailty trajectories. RESULTS: The study identified distinct trends in the frailty of elderly patients with Chronic Obstructive Pulmonary Disease (COPD). The group trajectory model revealed three classifications: Group 1, Pre-frail Rapidly Developing Group" (28.87%); Group 2, Pre-frail Sustainable Group" (41.23%); and Group 3, High Frailty Persistent Group" (29.90%). The results of the disordered multi-categorical logistic analysis indicated that, when comparing the Group1 and Group 2, a higher number of hospitalizations for acute exacerbations (≥ 2) was associated with older age, elevated IL-6 levels which increased the likelihood of a greater trajectory in the Pre-frail Sustainable Group (P < 0.05). In both the Group2 and Group3, a higher number of hospitalizations for acute exacerbations of COPD (≥ 2) correlated with lower frequency of social activities, older age, increased eosinophil percentage (EOS%), a smaller FEV1/FVC ratio, and higher IL-6 levels, all of which contributed to a greater likelihood of a High Frailty Persistent trajectory (P < 0.05). CONCLUSIONS: The observed frailty progression underscores the need for early screening and targeted interventions in high-risk COPD patients, particularly those with recurrent exacerbations or systemic inflammation. Future studies should explore whether attenuating frailty progression improves long-term outcomes.