Factors affecting frailty syndrome in chronic obstructivepulmonary disease patients and its relationship withsystemic inflammation

Introduction and Aim: Frailty is defined as a geriatric syndrome characterized by weakness resulting from aging, reduced physiological reserves, and more easily and more affected by any type of stress. This syndrome is becoming more and more important considering the increasing life expectancy. The aim of this study was to identify the factors affecting the frailty syndrome in COPD patients and to investigate its relationship with systemic inflammation. Materials and Methods: The study was carried out with 64 patients between the ages of 65-84 and diagnosed as COPD according to GOLD 2019 criteria. Cases with a systemic inflammatory disease or malignancy that were exacerbated and did not accept the study were excluded. Written informed consent was obtained after informing the patients about the study, demographic data, body mass index, COPD risk group according to GOLD, comorbidities, drugs used by patients, number of exacerbations, number of hospitalizations, exacerbation frequency, mMRC and CAT The study forms including the scores were filled in by face-to-face interviews. Pulmonary function test, 6 min walk test and Tilburg Frailty Test were performed in all cases. Blood samples were collected from both the flat tube and EDTA tube and stored in the freezer for systemic inflammation, N/L ratio, hsCRP, IL-6, 8OH-dG, IL-18. Then, all samples were thawed together and studied with human ELISA kits. For statistical evaluation, patients were divided into two groups as frail (Group 2) and non-frail (Group 1) according to Tilburg test results. Statistical analysis was performed using SPSS-21 statistical analysis software. The difference between the two groups was evaluated by independent sample t-test and Mann-Whitney U test. Pearson correlation test and two-tailed test were used for correlation. Results: While 71.9% of the cases were between 65-74 years, 18% were between 75-84 years. According to Tilburg test, 63.9% of the patients were evaluated as frail. 42 There was a statistically significant relationship between BMI and Tilburg frailty score (p: 0.035). BMI was low in the frail group and high in the non-frail group. There was a negative correlation between frail and weight (p: 0.304). There was a statistically significant relationship between the number of comorbidity and Tilburg frailty score (p: 0.007). The number of comorbidity was higher in the frail group and less in the non-frail group. There was a positive correlation between frailty and the number of drugs used (p: 0.390). The frailty score was significantly higher in GOLD group B&C group than in A&D group (p: 0.006). There was a statistically significant difference between frailtys and 6MWT percentage (p: 0.044). The percentage of 6MWT distance was found to be low (13.39 ± 7.89) in patients who were frail (group 2) and high (56.55 ± 12.87) in non-frail patients (group 1) (p: 0.044). A statistically significant difference was found between the frail and non-frail groups in terms of NLR (mkrL) values (p: 0.007). The NLR was significantly higher in the frail group than in the non-frail group. There was no statistically significant difference between HsCRP (ng/mL), IL-6 (ng/L), IL-18 (ng/L) and 8-oHDG (ng/mL) values between frail and non-frail groups (p> 0). No significant correlation was found between systemic inflammation and oxidative stress indicators and Tilburg frailty score (p> 0.05). Conclusion: According to our results, Tilburg frailty score is parallel to parameters such as GOLD stage, BMI, number of comorbidity and number of drugs, CAT score, 6 min walk test percentage used to evaluate COPD patients. Routine assessment of frailty in addition to COPD control may hinder the progression of frailty, provide doctors with additional important information in the follow-up of COPD and allow early interventions, including referrals to physical and respiratory rehabilitation, geriatric and nutritional specialists. Key Words: Frailty Syndrome, Frailty Index, COPD, Systemic Inflammation, hsCRP