Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
Lancet Healthy Longev. 2024 Aug;5(8):e534-e541. doi: 10.1016/S2666-7568(24)00114-4. Epub 2024 Jul 31.
Pleural disease is common, representing 5% of the acute medical workload, and its incidence is rising, partly due to the ageing population. Frailty is an important feature and little is known about disease progression in patients with frailty and pleural disease. We aimed to examine the effect of frailty on mortality and other relevant outcomes in patients diagnosed with pleural disease.
In this cohort study in Wales, the national Secure Anonymised Information Linkage databank was used to identify a cohort of individuals diagnosed with non-malignant pleural disease between Jan 1, 2005, and March 1, 2023, who were not known to have left Wales. Frailty was assessed at diagnosis of pleural disease using an electronic Frailty Index. The primary outcome was time from diagnosis to all-cause mortality for all patients. Data were analysed using multilevel mixed-effects Cox proportional hazards regression adjusting for the prespecified covariates of age, sex, Welsh Index of Multiple Deprivation quintile, smoking status, comorbidity, and subtype of pleural disease.
54 566 individuals were included in the final sample (median age 66 years [IQR 47-77]; 26 477 [48·5%] were female and 28 089 [51·5%] were male). By the end of the study period, 25 698 (47·1%) participants had died, with a median follow-up of 1·0 years (IQR 0·2-3·6). There was an association between frailty and all-cause mortality, which increased as frailty worsened. Compared with fit individuals, there was increasing mortality for those with mild frailty (adjusted hazard ratio 1·11 [95% CI 1·08-1·15]; p<0·0001), moderate frailty (1·25 [1·20-1·31]; p<0·0001), and severe frailty (1·36 [1·28-1·44]; p<0·0001).
Independent of age and comorbidities, frailty status at diagnosis of pleural disease appeared to be useful as a prognostic indicator. Patients with moderate or severe frailty had a rapid decline in health. Future patients should be assessed for frailty at the time of diagnosis of pleural disease and might benefit from optimised care and advance care planning.
Cardiff University's Wellcome Trust iTPA funding award.
胸膜疾病很常见，占急性医疗工作量的 5%，其发病率正在上升，部分原因是人口老龄化。虚弱是一个重要特征，对于患有虚弱和胸膜疾病的患者的疾病进展知之甚少。我们旨在研究虚弱对患有胸膜疾病的患者的死亡率和其他相关结局的影响。
在威尔士的这项队列研究中，国家安全匿名信息链接数据库用于确定 2005 年 1 月 1 日至 2023 年 3 月 1 日期间诊断患有非恶性胸膜疾病且尚未离开威尔士的患者队列。使用电子虚弱指数在诊断胸膜疾病时评估虚弱情况。主要结局是所有患者从诊断到全因死亡率的时间。使用多水平混合效应 Cox 比例风险回归分析数据，调整了年龄、性别、威尔士多维贫困五分位数、吸烟状况、合并症和胸膜疾病亚型等预设协变量。
最终样本纳入 54566 名患者（中位年龄 66 岁[四分位距 47-77]；26477 名[48.5%]为女性，28089 名[51.5%]为男性）。在研究结束时，25698 名（47.1%）参与者死亡，中位随访时间为 1.0 年（四分位距 0.2-3.6）。虚弱与全因死亡率之间存在关联，且随着虚弱程度的恶化而增加。与健康个体相比，轻度虚弱者（调整后的危险比 1.11[95%CI 1.08-1.15]；p<0.0001）、中度虚弱者（1.25[1.20-1.31]；p<0.0001）和重度虚弱者（1.36[1.28-1.44]；p<0.0001）的死亡率均升高。
独立于年龄和合并症，胸膜疾病诊断时的虚弱状况似乎可用作预后指标。患有中度或重度虚弱的患者健康状况迅速恶化。未来的患者在诊断胸膜疾病时应进行虚弱评估，他们可能会受益于优化的护理和提前护理计划。
卡迪夫大学惠康信托 iTPA 资助奖。
