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ObjectivesThe relationship between physical or cognitive frailty and chronic obstructive pulmonary disease (COPD) has been established. This study aimed to evaluate the association between social frailty and disease severity as well as prognosis in people with COPD.MethodsEligible people with stable COPD were prospectively enrolled. Baseline data were collected via medical records and face-to-face interviews, and social frailty was assessed using the Makizako Index (grouping criteria). During a 1-year follow-up, changes in participants' disease status and prognostic outcomes were recorded. Multivariate logistic regression was applied to analyze the associations.ResultsOf 725 participants, 281 had social frailty and 444 were non-frail. Baseline social frailty was associated with a greater number of previous acute exacerbations (p<0.001); with a higher risk of frequent acute exacerbations during follow-up (p<0.001); and with higher risks of hospitalization >7 days and ICU stay >3 days at the first acute exacerbation during follow-up (p<0.001, p=0.006). It also predicted greater dyspnea, abnormal blood gas, worse pulmonary function, elevated inflammatory markers, triple therapy escalation, and escalated steroids during this acute exacerbation (all p<0.01).ConclusionSocial frailty may, to a certain extent, serve as a potential predictor for assessing the prognosis of people with COPD.