Could Disease Severity and Inflammatory Markers (IL-6, Hs-CRP, TNF-α) be Related to Frailty in COPD? A Prospective Study

Abstract

Chronic Obstructive Pulmonary Disease (COPD) causes major morbidity and mortality worldwide. Various tools like ABCD assessment tool, COPD assessment tool (CAT) and mMRC dyspnea scale are employed to assess extent of disease progression and guide therapy. Since COPD involves chronic lung inflammation, serum levels of several inflammatory markers may relate to disease severity. Frailty is physiological age-related state of increased vulnerability to adverse health outcomes. We hereby correlate frailty in COPD patients with disease severity and serum concentrations of inflammatory markers (IL-6, hs-CRP, TNF-α). Material: Thirty COPD patients above age of 60 years from tertiary care diagnosed by spirometry were included after excluding other chronic comorbidities. IL-6, TNF-α levels using ELISA and hs-CRP levels using BN II Nephelometery were measured. Disease severity was stratified using ABCD assessment tool, CAT scores and mMRC grades. Frailty was assessed using Fried Frailty index and related to COPD severity and serum IL-6, hs-CRP, TNF-α. Observation: Mean age (in years) of the participants was 65.60±4.94. 60% were males, 40% were females. Most of them (76.7%) were frail. 10% belonged to GOLD Class 1, 40% to Class 2, 36.7% to Class 3, 13.3% to Class 4. 10% participants belonged to ABCD severity category A, 30% to category B, 6.7% to category C, 53.3% belonged to category D. 16.7% participants had mMRC Grade 1, 36.7% had Grade 2, 26.7% had Grade 3, 20.0% had Grade 4. The mean CAT score was 22.57 ± 8.83. The mean value of IL-6 (pg/mL) was 96.59 ± 112.01, of TNF-α (pg/mL) was 19.02 ± 21.07, and of hs-CRP (mg/L) was 37.58 ± 45.67. A significant association (p<0.001) existed between fraity and COPD severity using COPD assessment tool, mMRC dyspnea scale and ABCD assessment tool (p<0.001). Frailty in COPD patients was also significantly associated with serum IL-6 (p=0.033) and hs-CRP (p=0.010) but not with TNF-α (p=0.077). Frailty had no significant association with age, gender or GOLD class (p>0.05) Conclusion: These findings have important clinical implications and can provide new insights into COPD management thereby improving quality of life, especially of frail COPD patients. However more such studies are warranted to better clarify this relationship.