Prevalence and prognostic impact of physical frailty in interstitial lung disease: A prospective cohort study.
interstitial lung disease
mortality
outcomes
physical frailty
prognostic value
rehabilitation
Journal
Respirology (Carlton, Vic.)
ISSN: 1440-1843
Titre abrégé: Respirology
Pays: Australia
ID NLM: 9616368
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
revised:
11
03
2021
received:
18
12
2020
accepted:
06
04
2021
pubmed:
21
4
2021
medline:
1
10
2021
entrez:
20
4
2021
Statut:
ppublish
Résumé
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). 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. 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). 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.
Sections du résumé
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
683-689Informations de copyright
© 2021 Asian Pacific Society of Respirology.
Références
Kolb M, Vašáková M. The natural history of progressive fibrosing interstitial lung diseases. Respir Res. 2019;20:57-7. https://doi.org/10.1186/s12931-019-1022-1.
Ley B, Collard HR, King TE Jr. Clinical course and prediction of survival in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2011;183:431-40. https://doi.org/10.1164/rccm.201006-0894CI.
Olson AL, Gifford AH, Inase N, Fernández Pérez ER, Suda T. The epidemiology of idiopathic pulmonary fibrosis and interstitial lung diseases at risk of a progressive-fibrosing phenotype. Eur Respir Rev. 2018;27:180077. https://doi.org/10.1183/16000617.0077-2018.
Rothman MD, Leo-Summers L, Gill TM. Prognostic significance of potential frailty criteria. J Am Geriatr Soc. 2008;56:2211-6. https://doi.org/10.1111/j.1532-5415.2008.02008.x.
Morley JE, Vellas B, van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14:392-7. https://doi.org/10.1016/j.jamda.2013.03.022.
Kim DS, Park JH, Park BK, Lee JS, Nicholson AG, Colby T. Acute exacerbation of idiopathic pulmonary fibrosis: frequency and clinical features. Eur Respir J. 2006;27:143-50. https://doi.org/10.1183/09031936.06.00114004.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-56. https://doi.org/10.1093/gerona/56.3.m146.
Lahousse L, Ziere G, Verlinden VJ, Zillikens MC, Uitterlinden AG, Rivadeneira F, et al. Risk of frailty in elderly with COPD: a population-based study. J Gerontol A Biol Sci Med Sci. 2016;71:689-95. https://doi.org/10.1093/gerona/glv154.
Kennedy CC, Novotny PJ, LeBrasseur NK, Wise RA, Sciurba FC, Benzo RP. Frailty and clinical outcomes in chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2019;16:217-24. https://doi.org/10.1513/AnnalsATS.201803-175OC.
Akinlabi K, Patel B, Johnston K, Adebajo B, Adebajo R, Alrajeh A, et al. Impact of physical frailty on pulmonary rehabilitation and hospitalisation in COPD. Eur Respir J. 2018;52 (Suppl 62):PA3642. https://doi.org/10.1183/13993003.congress-2018.PA3642.
Montgomery E, Macdonald PS, Newton PJ, Chang S, Jha SR, Hannu MK, et al. Frailty as a predictor of mortality in patients with interstitial lung disease referred for lung transplantation. Transplantation. 2020;104(4):864-872
Guler SA, Kwan JM, Leung JM, Khalil N, Wilcox PG, Ryerson CJ. Functional aging in fibrotic interstitial lung disease: the impact of frailty on adverse health outcomes. Eur Respir J. 2020;55(1):1900647. https://doi.org/10.1183/13993003.00647-2019.Print 2020 Jan. https://pubmed.ncbi.nlm.nih.gov/31537699/
Ryerson CJ, Tan B, Fell CD, Manganas H, Shapera S, Mittoo S, et al. The Canadian Registry for Pulmonary Fibrosis: design and rationale of a National Pulmonary Fibrosis Registry. Can Respir J. 2016;2016:3562923. https://doi.org/10.1155/2016/3562923.
Ryerson CJ, Vittinghoff E, Ley B, Lee JS, Mooney JJ, Jones KD, et al. Predicting survival across chronic interstitial lung disease: the ILD-GAP model. Chest. 2014;145:723-8. https://doi.org/10.1378/chest.13-1474.
Theou O, Cann L, Blodgett J, Wallace LM, Brothers TD, Rockwood K. Modifications to the frailty phenotype criteria: systematic review of the current literature and investigation of 262 frailty phenotypes in the Survey of Health, Ageing, and Retirement in Europe. Ageing Res Rev. 2015;21:78-94. https://doi.org/10.1016/j.arr.2015.04.001.
Beaudart C, Rolland Y, Cruz-Jentoft AJ, Bauer JM, Sieber C, Cooper C, et al. Assessment of muscle function and physical performance in daily clinical practice. Calcif Tissue Int. 2019;105:1-14. https://doi.org/10.1007/s00223-019-00545-w.
Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc. 1999;94:496-509. https://doi.org/10.1080/01621459.1999.10474144.
Farooqi MAM, Gerstein H, Yusuf S, Leong DP. Accumulation of deficits as a key risk factor for cardiovascular morbidity and mortality: a pooled analysis of 154 000 individuals. J Am Heart Assoc. 2020;9:e014686. https://doi.org/10.1161/jaha.119.014686.
Walston J, Buta B, Xue Q-L. Frailty screening and interventions: considerations for clinical practice. Clin Geriatr Med. 2018;34:25-38. https://doi.org/10.1016/j.cger.2017.09.004.
Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, et al. Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev. 2016;26:53-61. https://doi.org/10.1016/j.arr.2015.12.003.
Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62:722-7. https://doi.org/10.1093/gerona/62.7.722.
Milne KM, Kwan JM, Guler S, Winstone TA, Le A, Khalil N, et al. Frailty is common and strongly associated with dyspnoea severity in fibrotic interstitial lung disease. Respirology. 2017;22:728-34. https://doi.org/10.1111/resp.12944.
Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49:M85-94. https://doi.org/10.1093/geronj/49.2.m85.
Farooqi MAM, Killian K, Satia I. The impact of muscle strength on exercise capacity and symptoms. ERJ Open Res. 2020;6:00089-2020. https://doi.org/10.1183/23120541.00089-2020.
Makhdami N, Farooqi M, Thom-Fernandes C, Raghavan NG. Pulmonary rehabilitation in interstitial lung diseases. Curr Opin Pulm Med. 2020;26(5):470-476.
Maddocks M, Kon SSC, Canavan JL, Jones SE, Nolan CM, Labey A, et al. Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study. Thorax. 2016;71:988-95. https://doi.org/10.1136/thoraxjnl-2016-208460.
Collard RM, Boter H, Schoevers RA, Oude Voshaar RC. Prevalence of frailty in community-dwelling older persons: a systematic review. J Am Geriatr Soc. 2012;60:1487-92. https://doi.org/10.1111/j.1532-5415.2012.04054.x.
Dudzińska-Griszek J, Szuster K, Szewieczek J. Grip strength as a frailty diagnostic component in geriatric inpatients. Clin Interv Aging. 2017;12:1151-7. https://doi.org/10.2147/CIA.S140192.
Weldring T, Smith SMS. Patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs). Health Serv Insights. 2013;6:61-8. https://doi.org/10.4137/HSI.S11093.