Guler, Sabina A.; Marinescu, Daniel-Costin; Cox, Gerard; Durand, Celine; Fisher, Jolene H; Grant-Orser, Amanda; Goobie, Gillian C; Hambly, Nathan; Johannson, Kerri A; Khalil, Nasreen; Kolb, Martin; Lok, Stacey; MacIsaac, Sarah; Manganas, Helene; Marcoux, Veronica; Morisset, Julie; Scallan, Ciaran; Shapera, Shane; Sun, Kelly; Zheng, Boyang; ... (2024). The clinical frailty scale for risk stratification in patients with fibrotic interstitial lung disease. Chest, 166(3), pp. 517-527. Elsevier 10.1016/j.chest.2024.02.043
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BACKGROUND
Previous studies have shown the importance of frailty in patients with fibrotic interstitial lung disease (ILD).
RESEARCH QUESTION
Is the Clinical Frailty Scale (CFS) a valid tool to improve risk stratification in patients with fibrotic ILD?
STUDY DESIGN AND 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 1-3), vulnerable (CFS 4), and frail (CFS 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 were used to establish prognostic performance. Trajectories of functional tests were compared using joint models.
RESULTS
Of the 1587 patients with fibrotic ILD, 858 (54%) were fit, 400 (25%) vulnerable and 329 (21%) frail. Frailty was a risk factor for early mortality (HR 5.58, 95%CI 3.64-5.76, p<0.001) 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. Frail patients had larger annual declines in forced vital capacity (FVC) %-predicted compared to fit patients (-2.32 (95%CI -3.39 to -1.17) vs. -1.55 (95%CI -2.04 to -1.15); p=0.02, respectively).
INTERPRETATION
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.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Rheumatology and Immunology 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology |
UniBE Contributor: |
Guler, Sabina Anna |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1931-3543 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
05 Mar 2024 09:07 |
Last Modified: |
13 Sep 2024 00:12 |
Publisher DOI: |
10.1016/j.chest.2024.02.043 |
PubMed ID: |
38423280 |
Uncontrolled Keywords: |
Aging Disease Progression Frailty Idiopathic Pulmonary Fibrosis Interstitial Lung Disease Survival |
BORIS DOI: |
10.48350/193650 |
URI: |
https://boris.unibe.ch/id/eprint/193650 |
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