The Clinical Frailty Scale for Risk Stratification in Patients With Fibrotic Interstitial Lung Disease.

aging disease progression frailty idiopathic pulmonary fibrosis interstitial lung disease survival

Journal

Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335

Informations de publication

Date de publication:
27 Feb 2024
Historique:
received: 12 01 2024
revised: 23 02 2024
accepted: 23 02 2024
pubmed: 1 3 2024
medline: 1 3 2024
entrez: 29 2 2024
Statut: aheadofprint

Résumé

Previous studies have shown the importance of frailty in patients with fibrotic interstitial lung disease (ILD). Is the Clinical Frailty Scale (CFS) a valid tool to improve risk stratification in patients with fibrotic ILD? Patients with fibrotic ILD were included from the prospective multicenter Canadian Registry for Pulmonary Fibrosis. The CFS was assessed using available information from initial ILD clinic visits. Patients were stratified into fit (CFS score 1-3), vulnerable (CFS score 4), and frail (CFS score 5-9) subgroups. Cox proportional hazards and logistic regression models with mixed effects were used to estimate time to death or lung transplantation. A derivation and validation cohort was used to establish prognostic performance. Trajectories of functional tests were compared using joint models. Of the 1,587 patients with fibrotic ILD, 858 (54%) were fit, 400 (25%) were vulnerable, and 329 (21%) were frail. Frailty was a risk factor for early mortality (hazard ratio, 5.58; 95% CI, 3.64-5.76, P < .001) in the entire cohort, in individual ILD diagnoses, and after adjustment for potential confounders. Adding frailty to established risk prediction parameters improved the prognostic performance in derivation and validation cohorts. Patients in the frail subgroup had larger annual declines in FVC % predicted than patients in the fit subgroup (-2.32; 95% CI, -3.39 to -1.17 vs -1.55; 95% CI, -2.04 to -1.15, respectively; P = .02). The simple and practical CFS is associated with pulmonary and physical function decline in patients with fibrotic ILD and provides additional prognostic accuracy in clinical practice.

Sections du résumé

BACKGROUND BACKGROUND
Previous studies have shown the importance of frailty in patients with fibrotic interstitial lung disease (ILD).
RESEARCH QUESTION OBJECTIVE
Is the Clinical Frailty Scale (CFS) a valid tool to improve risk stratification in patients with fibrotic ILD?
STUDY DESIGN AND METHODS METHODS
Patients with fibrotic ILD were included from the prospective multicenter Canadian Registry for Pulmonary Fibrosis. The CFS was assessed using available information from initial ILD clinic visits. Patients were stratified into fit (CFS score 1-3), vulnerable (CFS score 4), and frail (CFS score 5-9) subgroups. Cox proportional hazards and logistic regression models with mixed effects were used to estimate time to death or lung transplantation. A derivation and validation cohort was used to establish prognostic performance. Trajectories of functional tests were compared using joint models.
RESULTS RESULTS
Of the 1,587 patients with fibrotic ILD, 858 (54%) were fit, 400 (25%) were vulnerable, and 329 (21%) were frail. Frailty was a risk factor for early mortality (hazard ratio, 5.58; 95% CI, 3.64-5.76, P < .001) in the entire cohort, in individual ILD diagnoses, and after adjustment for potential confounders. Adding frailty to established risk prediction parameters improved the prognostic performance in derivation and validation cohorts. Patients in the frail subgroup had larger annual declines in FVC % predicted than patients in the fit subgroup (-2.32; 95% CI, -3.39 to -1.17 vs -1.55; 95% CI, -2.04 to -1.15, respectively; P = .02).
INTERPRETATION CONCLUSIONS
The simple and practical CFS is associated with pulmonary and physical function decline in patients with fibrotic ILD and provides additional prognostic accuracy in clinical practice.

Identifiants

DOI: 10.1016/j.chest.2024.02.043 PMID: 38423280
pubmed: 38423280
pii: S0012-3692(24)00279-4
doi: 10.1016/j.chest.2024.02.043
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Financial/Nonfinancial Disclosures None declared.

Auteurs

Sabina A Guler (SA)

Department for Pulmonary Medicine, Allergology and Clinical Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Lung Precision Medicine (LPM), Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland. Electronic address: sabina.guler@insel.ch.

Daniel-Costin Marinescu (DC)

Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.

Gerard Cox (G)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Celine Durand (C)

Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.

Jolene H Fisher (JH)

Department of Medicine, University of Toronto, Toronto, ON, Canada.

Amanda Grant-Orser (A)

Department of Medicine, University of Calgary, Calgary, AB, Canada.

Gillian C Goobie (GC)

Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Human Genetics, School of Public Health, University of Pittsburgh, Pittsburgh, PA.

Nathan Hambly (N)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Kerri A Johannson (KA)

Department of Medicine, University of Calgary, Calgary, AB, Canada.

Nasreen Khalil (N)

Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

Martin Kolb (M)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Stacey Lok (S)

Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

Sarah MacIsaac (S)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Helene Manganas (H)

Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.

Veronica Marcoux (V)

Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

Julie Morisset (J)

Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.

Ciaran Scallan (C)

Department of Medicine, McMaster University, Hamilton, ON, Canada.

Shane Shapera (S)

Department of Medicine, University of Toronto, Toronto, ON, Canada.

Kelly Sun (K)

Department of Medicine, University of Toronto, Toronto, ON, Canada.

Boyang Zheng (B)

Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Division of Rheumatology, McGill University, Montreal, QC, Canada.

Christopher J Ryerson (CJ)

Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.

Alyson W Wong (AW)

Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.

Classifications MeSH