Prevalence and prognostic impact of physical frailty in interstitial lung disease: A prospective cohort study
Prevalence and prognostic impact of physical frailty in interstitial lung disease: A prospective cohort study
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DOI：
10.1111/resp.14066
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发表时间：
2021-04-19
期刊：
影响因子：
6.9
通讯作者：
Kolb, Martin
中科院分区：
文献类型：
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作者：
Farooqi, Mohammed A. Malik;O'Hoski, Sachi;Kolb, Martin
背景和目的在老年人中，身体虚弱与死亡率和住院率增加有关。我们描述了纤维性间质性肺疾病(ILD)患者中身体虚弱的患病率及其对预后的影响。方法对麦克马斯特大学ILD项目中的纤维性ILD患者进行前瞻性随访，从2015年11月到2020年3月。根据修订的Fred身体虚弱标准，使用基线数据将患者分为非虚弱(得分=0)、虚弱前(得分=1-2)或虚弱(得分=3-5)。结果463名患者(男性占55%，平均年龄68[11]岁)；82名(18%)非体弱患者；258名(56%)体弱前期患者；123例(26%)体弱患者。最常见的ILD诊断为特发性肺纤维化(n=183，40%)和结缔组织病相关性ILD(n=79，17%)。平均诊断时间为2.7+/-4.6年。中位随访时间为1.71年(四分位数区间为1.24，2.31)，共有56人死亡。在基线水平上，虚弱和虚弱前期个体的死亡风险均高于非虚弱个体(调整后的危险比[AHR]4.14，95%可信区间1.27-13.5；虚弱前期为4.41，95%可信区间1.29-15.1)。对身体虚弱的评估为公认的风险评分(如ILD-GAP评分)提供了额外的预后价值，并可能为干预提供一个可修改的目标。
Background and objective Physical frailty is associated with increased mortality and hospitalizations in older adults. We describe the prevalence of physical frailty and its prognostic impact in patients with a spectrum of fibrotic interstitial lung disease (ILD).Methods Patients with fibrotic ILD at the McMaster University ILD programme were prospectively followed up from November 2015 to March 2020. Baseline data were used to classify patients as non-frail (score = 0), pre-frail (score = 1-2) or frail (score = 3-5) based on modified Fried physical frailty criteria. The association between physical frailty and mortality was assessed using time-to-event models, adjusted for age, sex, lung function and diagnosis using the ILD Gender-Age-Physiology (ILD-GAP) score.Results We included 463 patients (55% male, mean [SD] age 68 [11] years); 82 (18%) were non-frail, 258 (56%) pre-frail and 123 (26%) frail. The most common ILD diagnoses were idiopathic pulmonary fibrosis (n = 183, 40%) and connective tissue disease-associated-ILD (n = 79, 17%). Mean time since diagnosis was 2.7 +/- 4.6 years. There were 56 deaths within the median follow-up of 1.71 (interquartile range [IQR] 1.24, 2.31) years. Both frail and pre-frail individuals had a higher risk of death compared to those categorized as non-frail at baseline (adjusted hazard ratio [aHR] 4.14, 95% CI 1.27-13.5 for pre-frail and aHR 4.41, 95% CI 1.29-15.1 for frail).Conclusion Physical frailty is prevalent in patients with ILD and is independently associated with an increased risk of death. Assessment of physical frailty provides additional prognostic value to recognized risk scores such as the ILD-GAP score, and may present a modifiable target for intervention.