Frailty is a predictive factor of readmission within 90 days of hospitalization for acute exacerbations of chronic obstructive pulmonary disease: a longitudinal study

Abstract

Background:Readmission after hospital discharge is common in patients with acute exacerbations (AE) of chronic obstructive pulmonary disease (COPD). Although frailty predicts hospital readmission in patients with chronic nonpulmonary diseases, no multidimensional frailty measures have been validated to stratify the risk for patients with COPD.Aim:The aim of this study was to explore multidimensional frailty as a potential risk factor for readmission due to a new exacerbation episode during the 90 days after hospitalization for AE-COPD and to test whether frailty could improve the identification of patients at high risk of readmission. We hypothesized that patients with moderate-to-severe frailty would be at greater risk for readmission within that period of follow up. A secondary aim was to test whether frailty could improve the accuracy with which to discriminate patients with a high risk of readmission. Our investigation was part of a wider study protocol with additional aims on the same study population.Methods:Frailty, demographics, and disease-related factors were measured prospectively in 102 patients during hospitalization for AE-COPD. Some of the baseline data reported were collected as part of a previously study. Readmission data were obtained on the basis of the discharge summary from patients’ electronic files by a researcher blinded to the measurements made in the previous hospitalization. The association between frailty and readmission was assessed using bivariate analyses and multivariate logistic regression models. Whether frailty better identifies patients at high risk for readmission was evaluated by area under the receiver operator curve (AUC).Results:Severely frail patients were much more likely to be readmitted than nonfrail patients (45% versus 18%). After adjusting for age and relevant disease-related factors in a final multivariate model, severe frailty remained an independent risk factor for 90-day readmission (odds ratio = 5.19; 95% confidence interval: 1.26–21.50). Age, number of hospitalizations for exacerbations in the previous year and length of stay were also significant in this model. Additionally, frailty improved the predictive accuracy of readmission by improving the AUC.Conclusions:Multidimensional frailty predicts the risk of early hospital readmission in patients hospitalized for AE-COPD. Frailty improved the accuracy of discriminating patients at high risk for readmission. Identifying patients with frailty for targeted interventions may reduce early readmission rates.

Modelling hospital readmissions under frailty conditions for healthy aging

“…Thus, it is only natural that recent past history is a powerful predictor for readmission in this population. Besides this, the next more relevant variable is the Fried aggregate frailty index, which is in agreement with recent literature where frailty has been found to predict hospital readmission and mortality in patients with heart failure (Rampersad et al, ), after Transcatheter Aortic Valve Implantation (Saji et al, ), with chronic obtrusive pulmonary disease (Bernabeu‐Mora et al, ), and in hip and knee arthroplasty (Shin et al, ; Traven et al, ). However, the definition of frailty indices are still a matter of debate.…”

“…Transcatheter Aortic Valve Implantation (Saji et al, 2018), with chronic obtrusive pulmonary disease (Bernabeu-Mora et al, 2017), and in hip and knee arthroplasty (Shin et al, 2016;Traven et al, 2019). However, the definition of frailty indices are still a matter of debate.…”

Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd

“…Echevarría et al, in a validation study of the PEARL index to predict readmission or mortality, proved that by broadening the MRC dyspnoea scale by including a level at which the patient needs help to get dressed or go to the bathroom, the predictive ability of the index improves and that it is better than other multidimensional indexes that only include clinical variables [34]. A similar finding was described in a small Spanish study using the Edmonton Scale of frailty [35]. Other studies have also described poor physical activity as a predictor of readmission [36].…”

Comorbidities and Readmissions in Survivors of Acute Hypercapnic Respiratory Failure

“…77 Frailty, measured with the Reported Edmonton Frail Scale, predicted the risk of readmission at 90 days in a prospective cohort of patients with acute exacerbation of COPD. 78 It has also been shown that patients with overlap syndrome who are not treated with home continuous positive airway pressure have a greater risk of exacerbation compared with the COPD-only group as mentioned above. 53 Since OSA is still underdiagnosed in COPD patients, particularly in those admitted to the ICU, untreated sleep-disordered breathing could contribute to high readmission rates and their treatment could potentially help to reduce readmissions.…”