Frailty phenotypes and mortality after lung transplantation: A prospective cohort study
Frailty phenotypes and mortality after lung transplantation: A prospective cohort study
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肺移植后脆弱表型与死亡率：一项前瞻性队列研究
DOI：
10.1111/ajt.14873
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发表时间：
2018-08-01
影响因子：
8.8
通讯作者：
Lederer, David J.
中科院分区：
文献类型：
--
作者：
Singer, Jonathan P.;Diamond, Joshua M.;Lederer, David J.
虚弱与肺移植候选者死亡率增加有关。我们试图确定虚弱（通过短期身体表现电池（SPPB）测量）与肺移植后死亡率之间的关联。在一项针对接受肺移植的成人的多中心前瞻性队列研究中，使用 SPPB（n=318）评估术前虚弱程度，并在二次分析中使用 Fried 虚弱表型（FFP；n=299）进行评估。我们使用倾向评分调整的 Cox 模型测试了肺移植后术前虚弱与死亡率之间的关联。我们使用多元逻辑回归根据虚弱状态计算了 1 年死亡率的后估计边缘化标准化风险。 SPPB 衰弱与 1 年和 4 年死亡率风险增加相关（调整后风险比 [aHR]：7.5；95% 置信区间 [CI]：1.6-36.0 和 aHR 3.8；95%CI：1.8-8.0）。 SPPB 每恶化 1 点，死亡风险就会增加 20%（aHR：1.20；95%CI：1.08-1.33）。体弱受试者在移植后第一年内死亡风险绝对增加 12.2%（95%CI：3.1%-21%）。在二次分析中，FFP 虚弱与术后第一年内死亡风险增加相关（aHR：3.8；95%CI：1.1-13.2），但与更长的随访时间无关。术前虚弱与肺移植后死亡风险增加相关。在这项多中心前瞻性队列研究中，术前身体虚弱与肺移植后死亡风险显着升高独立相关。
Frailty is associated with increased mortality among lung transplant candidates. We sought to determine the association between frailty, as measured by the Short Physical Performance Battery (SPPB), and mortality after lung transplantation. In a multicenter prospective cohort study of adults who underwent lung transplantation, preoperative frailty was assessed with the SPPB (n=318) and, in a secondary analysis, the Fried Frailty Phenotype (FFP; n=299). We tested the association between preoperative frailty and mortality following lung transplantation with propensity score-adjusted Cox models. We calculated postestimation marginalized standardized risks for 1-year mortality by frailty status using multivariate logistic regression. SPPB frailty was associated with an increased risk of both 1- and 4-year mortality (adjusted hazard ratio [aHR]: 7.5; 95% confidence interval [CI]: 1.6-36.0 and aHR 3.8; 95%CI: 1.8-8.0, respectively). Each 1-point worsening in SPPB was associated with a 20% increased risk of death (aHR: 1.20; 95%CI: 1.08-1.33). Frail subjects had an absolute increased risk of death within the first year after transplantation of 12.2% (95%CI: 3.1%-21%). In secondary analyses, FFP frailty was associated with increased risk of death within the first postoperative year (aHR: 3.8; 95%CI: 1.1-13.2) but not over longer follow-up. Preoperative frailty is associated with an increased risk of death after lung transplantation.In this multicenter prospective cohort study, preoperative physical frailty is independently associated with a substantially higher risk of mortality after lung transplantation.