Short-term prognostic value of forced expiratory volume in 1 second divided by height cubed in a prospective cohort of people 80 years and older

BACKGROUND: Spirometry-based parameters of pulmonary function such as forced expiratory volume in 1 second (FEV(1)) have prognostic value beyond respiratory morbidity and mortality. FEV(1) divided by height cubed (FEV(1)/Ht(3)) has been found to be better at predicting all-cause mortality than the usual standardization as percentage of predicted "normal values" (FEV(1)%) and its use is independent of reference equations. Yet, limited data are available on the very old adults (80 years and older) and in association to other adverse health outcomes relevant for this age group. This study aims to investigate the short-term prognostic value of FEV(1)/Ht(3) for all-cause mortality, hospitalization, physical and mental decline in a cohort of very old adults. METHODS: In a population-based prospective cohort study of 501 very old adults in Belgium, comprehensive geriatric assessment and spirometry were performed at baseline and after 1.7 ± 0.21 years. Kaplan-Meier curves for 3-year all-cause mortality and hospitalization rates and multivariable analysis adjusted for age, sex, smoking status, co-morbidities, anemia, high C reactive protein and creatinine levels examined the association of FEV(1)/Ht(3) with all-cause mortality, unplanned hospitalization and decline in mental and physical functioning. Physical functioning was assessed by activities of daily living, a battery of physical performance tests and grip strength. Mental functioning was assessed with mini mental state examination and 15 items geriatric depression scale. RESULTS: Individuals in the lowest quartile of FEV(1)/Ht(3) had a statistically significant increased adjusted risk for all-cause mortality (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.10-2.60) and unplanned hospitalization (HR 1.65, 95% CI 1.21-2.25), as well as decline in physical (odds ratio [OR] 1.89, 95% CI 1.05-3.39) and mental functioning (OR 2.39, 95% CI 1.30-4.40) compared to the rest of the study population. CONCLUSIONS: In a cohort of very old adults, low FEV(1) expressed as FEV(1)/Ht(3) was found to be a short-term predictor of all-cause mortality, hospitalization and decline in physical and mental functioning independently of age, smoking status, chronic lung disease and other co-morbidities. Further research is needed on FEV(1)/Ht(3) as a potential risk marker for frailty and adverse health outcomes in this age group.