Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Chest. 2022 May;161(5):1320-1329. doi: 10.1016/j.chest.2021.11.008. Epub 2021 Nov 14.
Mortality risk assessment in interstitial lung disease (ILD) is challenging. Our objective was to determine the prognostic significance of BMI and change in weight in the most common fibrotic ILD subtypes.
Could BMI and weight loss over time be reliable prognostic indicators in patients with fibrotic ILD?
This observational retrospective multicenter cohort study enrolled patients with fibrotic ILD from the six-center CAnadian REgistry for Pulmonary Fibrosis (CARE-PF, derivation) and the ILD registry at the University of California, San Francisco (UCSF, validation). Patients were subcategorized as underweight (BMI < 18.5), normal weight (BMI 18.5-24.9), overweight (BMI 25-29.9), or obese (BMI > 30). Annual change in weight was calculated for all years of follow-up as the slope of best fit using the least square method based on every available measurement. Separate multivariable analyses evaluated the associations of BMI and change in weight with mortality, adjusting for common prognostic variables.
The derivation and validation cohorts included 1,786 and 1,779 patients, respectively. Compared with patients with normal BMI, mortality was highest in patients who were underweight (hazard ratio [HR], 3.19; 95% CI, 1.88-5.43; P < .001) and was lowest in those who were overweight (HR, 0.52; 95% CI, 0.36-0.75; P < .001) or obese (HR, 0.55; 95%CI, 0.37-0.83; P < .001) in the analysis adjusted for the ILD-GAP (gender, age, physiology) Index. Patients who had a weight loss of at least 2 kg within 1 year had increased risk of death in the subsequent year (HR, 1.41; 95% CI, 1.01-1.97; P = .04) after adjustment for the ILD-GAP Index and baseline BMI category, with a plateau in risk for patients with greater weight loss. Consistent results were observed in the validation cohort.
Both BMI and weight loss are independently associated with 1-year mortality in fibrotic ILD. BMI and weight loss may be clinically useful prognostic indicators in fibrotic ILD.
间质性肺病（ILD）的死亡率评估具有挑战性。我们的目的是确定 BMI 和体重变化在最常见的纤维化 ILD 亚型中的预后意义。
BMI 和随时间推移的体重减轻能否成为纤维化 ILD 患者可靠的预后指标？
这是一项观察性回顾性多中心队列研究，纳入了来自加拿大肺纤维化注册中心（CARE-PF，推导）和加利福尼亚大学旧金山分校（UCSF，验证）ILD 登记处的纤维化 ILD 患者。患者被分为体重不足（BMI<18.5）、正常体重（BMI 18.5-24.9）、超重（BMI 25-29.9）或肥胖（BMI>30）。使用最小二乘法基于每个可用测量值计算所有随访年的体重变化的年度斜率，作为最佳拟合斜率。单独的多变量分析评估了 BMI 和体重变化与死亡率的相关性，调整了常见的预后变量。
推导队列和验证队列分别纳入了 1786 例和 1779 例患者。与 BMI 正常的患者相比，体重不足的患者死亡率最高（风险比[HR]，3.19；95%CI，1.88-5.43；P<.001），超重（HR，0.52；95%CI，0.36-0.75；P<.001）或肥胖（HR，0.55；95%CI，0.37-0.83；P<.001）的患者死亡率最低，该分析调整了 ILD-GAP（性别、年龄、生理）指数。在调整了 ILD-GAP 指数和基线 BMI 类别后，在 1 年内体重至少减轻 2kg 的患者在随后的 1 年内死亡风险增加（HR，1.41；95%CI，1.01-1.97；P=0.04），体重减轻更多的患者风险趋于平稳。在验证队列中观察到了一致的结果。
BMI 和体重减轻均与纤维化 ILD 的 1 年死亡率独立相关。BMI 和体重减轻可能是纤维化 ILD 临床有用的预后指标。
