Academic Respiratory Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.
Respiratory Unit, Department of Surgical and Medical Sciences, University of Modena and Reggio Emilia, Policlinico Modena, Italy.
BMC Pulm Med. 2024 Apr 16;24(1):180. doi: 10.1186/s12890-024-02981-3.
There are currently no data on the relationship between frailty and mortality in pleural disease. Understanding the relationship between frailty and outcomes is increasingly important for clinicians to guide decisions regarding investigation and management. This study aims to explore the relationship between all-cause mortality and frailty status in patients with pleural disease.
In this retrospective analysis of a prospectively collected observational cohort study, outpatients presenting to the pleural service at a tertiary centre in Bristol, UK with a radiologically confirmed, undiagnosed pleural effusion underwent comprehensive assessment and were assigned a final diagnosis at 12 months. The modified frailty index (mFI) was calculated and participants classified as frail (mFI ≥ 0.4) or not frail (mFI ≤ 0.2).
676 participants were included from 3rd March 2008 to 29th December 2020. The median time to mortality was 490 days (IQR 161-1595). A positive association was found between 12-month mortality and frailty (aHR = 1.72, 95% CI 1.02-2.76, p = 0.025) and age ≥ 80 (aHR = 1.80, 95% CI 1.24-2.62, p = 0.002). Subgroup analyses found a stronger association between 12-month mortality and frailty in benign disease (aHR = 4.36, 95% CI 2.17-8.77, p < 0.0001) than in all pleural disease. Malignancy irrespective of frailty status was associated with an increase in all-cause mortality (aHR = 10.40, 95% CI 6.01-18.01, p < 0.0001).
This is the first study evaluating the relationship between frailty and outcomes in pleural disease. Our data demonstrates a strong association between frailty and 12-month mortality in this cohort. A malignant diagnosis is an independent predictor of 12-month mortality, irrespective of frailty status. Frailty was also strongly associated with 12-month mortality in patients with a benign underlying cause for their pleural disease. This has clinical relevance for pleural physicians; evaluating patients' frailty status and its impact on mortality can guide clinicians in assessing suitability for invasive investigation and management.
This study is registered with the Health Research Authority (REC reference 08/H0102/11) and the NIHR Portfolio (Study ID 8960).
目前尚无关于衰弱与胸膜疾病死亡率之间关系的数据。了解衰弱与结局之间的关系对临床医生指导有关调查和管理的决策越来越重要。本研究旨在探讨胸膜疾病患者全因死亡率与衰弱状况之间的关系。
在这项对前瞻性收集的观察性队列研究的回顾性分析中，来自英国布里斯托尔一家三级中心胸膜科就诊的经放射学证实的不明原因胸腔积液的门诊患者接受了全面评估，并在 12 个月时确定了最终诊断。计算改良衰弱指数（mFI）并将参与者分为衰弱（mFI≥0.4）或非衰弱（mFI≤0.2）。
2008 年 3 月 3 日至 2020 年 12 月 29 日期间纳入了 676 名参与者。中位死亡时间为 490 天（IQR 161-1595）。12 个月死亡率与衰弱呈正相关（aHR=1.72，95%CI 1.02-2.76，p=0.025）和年龄≥80 岁（aHR=1.80，95%CI 1.24-2.62，p=0.002）。亚组分析发现，衰弱与良性疾病（aHR=4.36，95%CI 2.17-8.77，p<0.0001）之间的 12 个月死亡率相关性比所有胸膜疾病更强。无论衰弱状况如何，恶性肿瘤均与全因死亡率增加相关（aHR=10.40，95%CI 6.01-18.01，p<0.0001）。
这是第一项评估胸膜疾病中衰弱与结局之间关系的研究。我们的数据表明，在该队列中，衰弱与 12 个月死亡率之间存在很强的关联。恶性诊断是 12 个月死亡率的独立预测因素，与衰弱状态无关。衰弱与胸膜疾病潜在良性病因患者的 12 个月死亡率也密切相关。这对胸膜科医生具有临床意义；评估患者的衰弱状态及其对死亡率的影响，可以指导临床医生评估其是否适合进行有创性检查和治疗。
该研究在英国健康研究管理局（REC 参考号 08/H0102/11）和英国国家健康研究所（研究 ID 8960）进行了注册。
