Montgomery Elyn, Newton Phillip J, Chang Sungwon, Peng Wenbo, Jha Sunita R, Wilhelm Kay, Macdonald Peter S, Malouf Monique
Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
School of Nursing and Midwifery, Western Sydney University, Sydney, NSW, Australia.
Transplantation. 2022 May 1;106(5):1084-1092. doi: 10.1097/TP.0000000000003823. Epub 2021 May 19.
The study aimed to determine whether the addition of cognitive impairment, depression, or both, to the assessment of physical frailty (PF) is associated with the risk of lung transplant (LTX) waitlist mortality.
Since March 2013, all patients referred for LTX evaluation underwent PF assessment. Cognition was assessed using the Montreal Cognitive Assessment and depression assessed using the Depression in Medical Illness questionnaire. We assessed the association of 4 composite frailty measures: PF ≥3 of 5 = frail, cognitive frailty (CogF ≥3 of 6 = frail), depressive frailty (DepF ≥3 of 6 = frail), and combined frailty (ComF ≥3 of 7 = frail) with waitlist mortality.
The prevalence of PF was 78 (22%), CogF 100 (28%), DepF 105 (29%), and ComF 124 (34%). Waitlist survival in the non-PF group was 94% ± 2% versus 71% ± 7% in the PF group (P < 0.001). Cox proportional hazards regression analysis demonstrated that PF (adjusted hazard ratio [HR], 4.88; 95% confidence interval [CI], 2.06-11.56), mild cognitive impairment (adjusted HR, 3.03; 95% CI, 1.05-8.78), and hypoalbuminemia (adjusted HR, 0.89; 95% CI, 0.82-0.97) were independent predictors of waitlist mortality. There was no significant difference in the area under the curve of the 4 frailty measures.
The addition of cognitive function and depression variables to the PF assessment increased the number of patients classified as frail. However, the addition of these variables does not strengthen the association with LTX waitlist mortality compared with the PF measure.
本研究旨在确定在身体虚弱（PF）评估中加入认知障碍、抑郁或两者，是否与肺移植（LTX）等待名单死亡率相关。
自2013年3月起，所有转诊进行LTX评估的患者均接受PF评估。使用蒙特利尔认知评估量表评估认知，使用疾病抑郁问卷评估抑郁。我们评估了4种综合虚弱指标：PF≥5项中的3项=虚弱，认知虚弱（CogF≥6项中的3项=虚弱），抑郁虚弱（DepF≥6项中的3项=虚弱），以及综合虚弱（ComF≥7项中的3项=虚弱）与等待名单死亡率的关联。
PF的患病率为78例（22%），CogF为100例（28%），DepF为105例（29%），ComF为124例（34%）。非PF组等待名单生存率为94%±2%，而PF组为71%±7%（P<0.001）。Cox比例风险回归分析表明，PF（调整后风险比[HR]，4.88；95%置信区间[CI]，2.06-11.56）、轻度认知障碍（调整后HR，3.03；95%CI，1.05-8.78）和低白蛋白血症（调整后HR，0.89；95%CI，0.82-0.97）是等待名单死亡率的独立预测因素。4种虚弱指标的曲线下面积无显著差异。
在PF评估中加入认知功能和抑郁变量会增加被分类为虚弱的患者数量。然而，与PF指标相比，加入这些变量并未加强与LTX等待名单死亡率的关联。
