Mismatch identified in symptom burden profiles in lung transplantation

Abstract

Background: There is considerable heterogeneity in symptom burden among lung transplant candidates that may not be explained by objective measures of illness severity.

Objectives: This study aimed to characterize symptom burden, identify distinct profiles based on symptom burden and illness severity, and determine whether observed profiles are defined by differences in social determinates of health (SDOH).

Methods: This was a prospective study of adult lung transplant candidates. Symptoms were assessed within 3 months of transplant with the Memorial Symptom Assessment Scale (MSAS). MSAS subscale (physical and psychological) scores range 0-4 (higher=more symptom burden). The lung allocation score (LAS) (range 0-100) was our proxy measure of illness severity. The MSAS subscales and LAS were used as continuous indicators in a latent profile analysis to identify distinct symptom-illness severity profiles. Comparative statistics were used to identify SDOH differences among observed profiles.

Results: Among 93 candidates, 3 distinct symptom-illness severity profiles were identified: 71% had a mild profile in which mild symptoms (MSAS physical 0.49; MSAS psychological 0.57) paired with mild illness severity (LAS 38.59). Of the 29% mismatched participants, 9% had moderate symptoms (MSAS physical 0.88; MSAS psychological 1.47) but severe illness severity (LAS 88.02) and 20% had severe symptoms (MSAS physical 1.30; MSAS psychological 1.94) but mild illness severity (LAS 42.13). The two mismatch profiles were younger, more racially diverse, and had higher psychosocial risk scores.

Conclusion: Symptom burden is heterogenous, does not always reflect objective measures of illness severity, and may be linked to SDOH.

Keywords: Lung transplantation; Patient reported outcomes; Quality of life; Social determinants of health; Symptoms.

Figure 1.. Latent Profile Analysis Method Flowchart

This figure presents procedural steps in the latent profile statistical analysis.

Figure 2.. Study Flow Diagram

This figure presents the participant enrollment process: eligibility prescreens, recruitment, and enrollment.

Figure 3:. Symptom Prevalence Among Study Cohort

This figure presents Symptoms prevalence: the Memorial Symptom Assessment Scale (MSAS)

Figure 4.. Total MSAS Symptom Burden Scores by Profile

This figure presents symptom burden scores (score range 0–4, higher scores indicate severe symptom burden): the Memorial Symptom Assessment Scale (MSAS). Each symptom burden score is presented by the observed symptom profile.