Frail Phenotype in Patients With Inflammatory Bowel Disease

Abstract

Background Recent retrospective studies have shown that frailty is common in hospitalized patients with inflammatory bowel disease (IBD) and enhances the risk of drug-related infections, postsurgery complications, hospital readmissions, and mortality, independently of age and comorbidities. We carried out a descriptive cohort study to evaluate the frequency of frail phenotype in IBD and analyzed the risk factors associated with this condition. Methods Frail phenotype was assessed in IBD patients by using the Fried frailty phenotype. Univariate and multivariate analyses were conducted to assess the risk factors for frail phenotype. Serum levels of interleukin (IL)-6 were quantified in patients with a frail or a fit phenotype by ELISA. Results Three hundred eighty-six IBD outpatients (198 Crohn’s disease and 188 ulcerative colitis) were prospectively enrolled from December 2021 to April 2022. Frail phenotype was diagnosed in 64 of 386 (17%) IBD patients and was significantly associated with female gender, active disease, and current use of steroids. Multivariate analysis showed that active disease was a risk factor for frail phenotype (odds ratio, 11.5; 95% confidence interval, 3.9-33.9). No difference in IL-6 serum levels was seen between patients with a frail phenotype and those who were fit. Conclusions This is the first prospective study showing that frail phenotype occurs in nearly one-fifth of IBD patients. Data indicate that active IBD is an independent risk factor for frail phenotype in IBD.

Reversibility of Frail Phenotype in Patients with Inflammatory Bowel Diseases

“…Those patients were then followed up with at the indicated time points to ascertain any change in their frail status. The Fried frailty phenotype is a clinical score investigating five different domains: unintentional weight loss, self-reported exhaustion, slow walking speed, low physical activity, and weakness [ 7 , 11 ]. Patients with three or more of the five scoring criteria were defined as “frail”, while they were defined as “pre-frail” in presence of one or two of these criteria.…”

“…By using the Fried frailty phenotype [ 7 ], a score that has been widely validated [ 8 , 9 , 10 ] and is easy to use during scheduled outpatient visits, we recently showed [ 11 ] that nearly one-fifth of patients with IBD who were prospectively assessed in our tertiary referral center had a frail phenotype. Although frailty was more frequent in patients older than 60 years, univariate and multivariate analyses demonstrated that elderly age was not a risk factor for frailty.…”

Sarcopenia and frailty in inflammatory bowel disease: Emerging concepts and evidence

“…However, in the age group of ≥60 years, the prevalence of frailty rose to 24.2% and there was no significant difference in the prevalence of frailty between UC and CD. They also have shown that disease activity, steroid usage, and extraintestinal manifestations were significantly higher in frail individuals and multivariate analysis showed that disease activity was an independent predictor of frailty 19 …”

“…Multivariate analysis found that frailty was associated with clinically active disease (OR:0.1, 95% CI: 0.01–0.6), extraintestinal manifestations (OR:0.1, 95% CI: 0.02–0.8), and is inversely related to biological use (OR:21.7, 95% CI: 3.4–263). This suggests that therapy with biologics may have a role in the improvement of frailty status 22 . Another prospective cohort study in elderly IBD patients measured frailty by geriatric deficit assessment and found a direct relationship between the number of geriatric deficits with clinical (OR:2.192, 95% CI: 1.284–3.743), biochemical disease activity (OR:3.358, 95% CI: 1.936–5.825), and fecal calprotectin levels (OR: 2.721, 95% CI: 1.376–5.379).…”

“…Aging is associated with multiple comorbidities, and people with IBD are no exception, resulting in polypharmacy adding to the pill burden in the elderly. This potentially leads to nonadherence to IBD treatment 19,35 . IBD also brings up a new spectrum of complications, especially in the elderly, associated with steroid use like cataracts and osteoporosis.…”