Exploring the Association Between Frailty and Adverse Clinical Outcomes in Inflammatory Bowel Disease
Creators: Bedard, Katherine
Publisher: name: University of Alberta Library
Year: 2022

<p>Background and Rationale: Chronological age does not always accurately reflect “biological age”, or the extent of physiological reserve an individual possesses to endure stressors. The concept of physiological reserve is best represented by frailty; a multifaceted syndrome or state that encompasses both sarcopenia and malnutrition. In patients with inflammatory bowel disease (IBD), frailty has been reported to be independently associated with mortality and other adverse clinical outcomes and may act as an important risk-stratification tool in this population.<br>
Purpose and Hypothesis: The purpose of this study was to determine if frailty, measured through the Clinical Frailty Scale (CFS), handgrip strength (HGS), the Subjective Global Assessment (SGA), the abridged Patient-Generated Subjective Global Assessment (abPG-SGA), or the Saskatchewan Inflammatory Bowel Disease Nutrition Risk Tool (SaskIBD-NRT), is associated with a higher risk of adverse clinical outcomes in outpatients with IBD. It is hypothesized that these clinical frailty markers will predict the risk of IBD-related hospitalizations and surgeries, such as colectomies and small bowel resections. <br>
Methods: Consecutive IBD patients ≥18 years of age at two ambulatory care clinics in Alberta were prospectively enrolled in this study. IBD patients with a major medical comorbidity (chronic renal failure requiring dialysis, chronic pulmonary disease, or congestive heart failure with an ejection fraction &lt;40%), previous colectomy, or those unable to provide informed consent were excluded. Patients who were pregnant or who had a disease duration under three months at the time of enrollment were also excluded. Frailty was defined using the CFS, HGS, the SGA, the abPG-SGA, or the SaskIBD-NRT. Differences between baseline characteristics, frailty, sarcopenia, and malnutrition measurements or scores were determined using independent sample two-sided t-tests for continuous data or Pearson’s chi-squared tests for categorical data. We constructed logarithm relative hazard graphs and Cox multivariable logistic regression models adjusting for the following confounders: age, sex, disease phenotype, clinical disease activity, exposure to biologics, exposure to steroids, previous IBD-related surgeries, and comorbidities (determined using the Charlson Comorbidity Index [CCI]; categorized into no comorbidities vs. ≥1 comorbidity). Multiple regression analyses were also completed, which also adjusted for the above listed confounders. A bivariate correlation test with a two-tailed test of significance was completed to analyze the possible correlation between the markers of frailty as well as with chronological age, where Spearman correlation coefficients were used to indicate the extent of the correlations. All statistical analyses were performed using SPSS statistical software (v28).<br>
Results: A total of 163 patients (35.6% Crohn’s disease [CD] and 64.4% ulcerative colitis [UC]), with a mean age of 42.3 (±15.9) years, who were 50.9% female, had a mean Harvey Bradshaw index score of 3.7 (±3.9) and mean partial Mayo score of 1.3 (±1.8), were followed over a mean period of 43.9 (±10.1) months. Twenty-seven patients were hospitalized and 13 patients underwent IBD-related surgeries following baseline. It was determined that patients defined as frail through HGS (aHR 3.922, P=0.034), the abPG-SGA (ordinal form: aHR 1.071, P=0.030), or the SaskIBD-NRT (ordinal form: aHR 1.370, P=0.018; categorical form, high risk [score ≥5]: aHR 4.578, P=0.014) each had a significantly increased risk of IBD-related hospital admissions. Finally, frailty defined using the abPG-SGA (β 0.001786, P=0.013) was associated with an increased proportion of time spent in hospital due to IBD-related reasons.<br>
Conclusion: HGS, a reflection of sarcopenia, and abPG-SGA as well as SaskIBD-NRT, both reflections of malnutrition, are frailty-defining entities that were all independently associated with an increased risk of IBD-related hospitalizations. The abPG-SGA was also independently associated with an increase in the proportion of time spent in hospital for IBD-related reasons. Future studies should aim to validate frailty, sarcopenia, and malnutrition tools in the IBD population in order to tailor care for all IBD patients.</p>