A Frailty Assessment Tool to Predict In-Hospital Mortality in Patients with Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Background: The exacerbation of chronic obstructive pulmonary disease (AECOPD) is a chronic, frequent, and life-threatening lung disease. In 2014, a frailty index (FI) based on deficits in commonly used laboratory tests (FI-Lab) was suggested to identify older adults at increased risk of death. Objective: We aim to study the prognostic value of the FI-Lab in older Chinese patients who were admitted because of AECOPD. Methods: We screened 1932 older patients hospitalized with AECOPD from September 2016 to June 2019 at Zhenjiang First People's Hospital, China. A multivariate logistic regression analysis was used to identify prognostic factors for in-hospital mortality. Results: A total of 77 survivors and 77 non-survivors were finally included in the study. Both the mean DECAF (including dyspnea, eosinopenia, consolidation, acidemia, and atrial fibrillation) score and the mean FI-Lab value of non-survivors were statistically higher than those of survivors (4.45 +/- 0.80 versus 3.03 +/- 0.90, P=0.000; 0.51 +/- 0.13 versus 0.29 +/- 0.10, P=0.000, respectively). Logistic regression analysis suggested that DECAF Rank and FI-Lab Rank were strongly related factors of death in AECOPD patients. The areas under the receiver-operating characteristic (ROC) curves were 0.906 for FI-Lab and 0.870 for DECAF (P=0.2991). Conclusion: FI-Lab is a simple, efficient, and objective tool to stratify the risk of in-hospital mortality of AECOPD.