The clinical frailty scale for risk stratification in patients with fibrotic interstitial lung disease.

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)

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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