Frailty nearly triples mortality odds in IBD
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Frailty was independently associated with mortality in a large cohort of patients with inflammatory bowel disease, according to study results.
Ashwin Ananthakrishnan, MD, of the division of gastroenterology at Massachusetts General Hospital, and colleagues wrote that improved treatments and increased global incidence mean that people with IBD are getting older.
“Frailty may be particularly pertinent in chronic inflammatory diseases with emerging evidence demonstrating that inflammation has a key role in the pathophysiology of frailty,” they wrote. “It is important to determine if the presence of frailty can be used to more accurately stratify mortality risk in patients in IBD.”
Using a validated code for frailty in the International Classification of Disease Codes, researchers compared patients with IBD with a frail code to patients with IBD without a frailty-related code (n = 11,001). They determined if frailty could predict mortality after adjusting for several clinical confounders, including IBD type, IBD surgery and immunosuppression use.
In the total cohort, 675 patients (6%) had a frailty-related diagnosis. Researchers found that the prevalence of frailty increased with age, from 4% among patients aged between 20 and 29 years to 25% among patients aged 90 years or older. Among the strongest predictors of frailty were non-IBD comorbidity, as well as all-cause and IBD-related hospitalization.
After adjusting for age, sex, duration of follow-up, comorbidity, need for IBD-related surgery and immunosuppression, researchers found that frailty remained independently associated with mortality among patients with IBD (OR = 2.9; 95% CI, 2.29-3.68).
“While the odds of death conferred by frailty was similar in older and younger patients, the significantly higher prevalence of frailty traits in older patients emphasizes the greater impact in this group on the population-level,” Ananthakrishnan and colleagues wrote. “With the rising burden of IBD in older individuals, there is an important need to systematically and prospectively investigate frailty in IBD patients in order to determine appropriate interventions to address frailty and prevent adverse events.
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