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.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, BC, Canada.
Chest. 2024 Sep;166(3):517-527. doi: 10.1016/j.chest.2024.02.043. Epub 2024 Feb 27.
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.
先前的研究表明，衰弱在纤维化间质性肺疾病（ILD）患者中具有重要意义。
临床虚弱量表（CFS）是否是改善纤维化ILD 患者风险分层的有效工具？
从前瞻性加拿大肺纤维化注册中心纳入纤维化ILD 患者。使用初始ILD 临床就诊时的可用信息评估 CFS。患者被分为健康（CFS 评分为 1-3）、脆弱（CFS 评分为 4）和衰弱（CFS 评分为 5-9）亚组。使用混合效应的 Cox 比例风险和逻辑回归模型来估计死亡或肺移植的时间。使用推导和验证队列来建立预后性能。使用联合模型比较功能测试的轨迹。
在 1587 例纤维化 ILD 患者中，858 例（54%）为健康，400 例（25%）为脆弱，329 例（21%）为衰弱。在整个队列、单个ILD 诊断以及在调整潜在混杂因素后，衰弱是早期死亡率的危险因素（危险比，5.58；95%CI，3.64-5.76，P<.001）。在推导和验证队列中，将衰弱纳入既定风险预测参数可改善预后性能。虚弱亚组的 FVC %预测值年下降幅度大于健康亚组（-2.32；95%CI，-3.39 至-1.17 与-1.55；95%CI，-2.04 至-1.15，分别；P=.02）。
简单实用的 CFS 与纤维化 ILD 患者的肺功能和身体功能下降相关，并在临床实践中提供额外的预后准确性。
