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. 2024 Jan-Dec:21:14799731241240786.
doi: 10.1177/14799731241240786.

Clinical implications of frailty assessed in hospitalized patients with acute-exacerbation of interstitial lung disease

Marine Van Hollebeke  1   2 , Karan Chohan  3 , Colin J Adams  4 , Jolene H Fisher  4   5 , Shane Shapera  2   4 , Lee Fidler  4   5   6 , Ewan C Goligher  2   7 , Tereza Martinu  2   4 , Lisa Wickerson  1   2 , Sunita Mathur  8 , Lianne G Singer  2   4 , W Darlene Reid  1   7   9 , Dmitry Rozenberg  2   4
Affiliations

Clinical implications of frailty assessed in hospitalized patients with acute-exacerbation of interstitial lung disease

Marine Van Hollebeke et al. Chron Respir Dis. 2024 Jan-Dec.

Abstract

Background: Approximately 50% of patients with interstitial lung disease (ILD) experience frailty, which remains unexplored in acute exacerbations of ILD (AE-ILD). A better understanding may help with prognostication and resource planning. We evaluated the association of frailty with clinical characteristics, physical function, hospital outcomes, and post-AE-ILD recovery.

Methods: Retrospective cohort study of AE-ILD patients (01/2015-10/2019) with frailty (proportion ≥0.25) on a 30-item cumulative-deficits index. Frail and non-frail patients were compared for pre- and post-hospitalization clinical characteristics, adjusted for age, sex, and ILD diagnosis. One-year mortality, considering transplantation as a competing risk, was analysed adjusting for age, frailty, and Charlson Comorbidity Index (CCI).

Results: 89 AE-ILD patients were admitted (median: 67 years, 63% idiopathic pulmonary fibrosis). 31 were frail, which was associated with older age, greater CCI, lower 6-min walk distance, and decreased independence pre-hospitalization. Frail patients had more major complications (32% vs 10%, p = .01) and required more multidisciplinary support during hospitalization. Frailty was not associated with 1-year mortality (HR: 0.97, 95%CI: [0.45-2.10]) factoring transplantation as a competing risk.

Conclusions: Frailty was associated with reduced exercise capacity, increased comorbidities and hospital complications. Identifying frailty may highlight those requiring additional multidisciplinary support, but further study is needed to explore whether frailty is modifiable with AE-ILD.

Keywords: Interstitial lung diseases; frailty; hospitalization; prevalence; symptom of acute exacerbations.

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Conflict of interest statement

Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Lee Fidler has received a grant from the Canadian Pulmonary Fibrosis Foundation and honoraria for speaking/lecturing from Boehringer Ingelheim, AstraZeneca, and Pfizer. Jolene Fisher acknowledges grants from Boehringer Ingelheim (for the Canadian Registry for Pulmonary Fibrosis) and payments made to the University of British Columbia, with subsequent support for the University of Toronto. She has received consulting fees and honoraria from AstraZeneca and Boehringer Ingelheim, as well as honoraria from Boehringer Ingelheim for a presentation. She serves as an unpaid Medical Advisory Board Member for the Canadian Pulmonary Fibrosis Foundation. W. Darlene Reid and Dmitry Rozenberg received a grant from the Canadian Institutes of Health Research for their project “Translating the interplay of cognition and physical performance to daily activities in COPD and ILD: Identifying Needs and Advancing Research Priorities. “Shane Shapera acknowledges a grant from Boehringer Ingelheim Canada and honoraria for speaking at CME events from AstraZeneca, Boehringer Ingelheim, and Hoffman La-Roche. All other authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Oxygen supplementation at rest: Oxygen supplementation was ascertained prior to admission with a median of 83 days (IQR: 53; 124) before admission. Oxygen supplementation not reported for one patient in non-frail group as required mechanical ventilation shortly after hospital admission.
Figure 2.
Figure 2.
One-year Survival and incidence of lung transplantation Post-Acute Interstitial Lung Disease Exacerbation: Panel A depicts a Kaplan-Meier plot for 1-year survival post exacerbation according to presence of frailty on hospital admission, including those transplanted. Four patients were censored for death given end of follow-up period. Panel B represents the cumulative incidence of lung transplantation post exacerbation according to presence of frailty on hospital admission, one patient was censored for lung transplantation.
See this image and copyright information in PMC

References

    1. Plantier L, Cazes A, Dinh-Xuan AT, et al. Physiology of the lung in idiopathic pulmonary fibrosis. Eur Respir Rev 2018; 27(147): 170062. - PMC - PubMed
    1. Collard HR, Ryerson CJ, Corte TJ, et al. Acute exacerbation of idiopathic pulmonary fibrosis. An international working group report. Am J Respir Crit Care Med 2016; 194(3): 265–275. - PubMed
    1. Miyashita K, Kono M, Saito G, et al. Prognosis after acute exacerbation in patients with interstitial lung disease other than idiopathic pulmonary fibrosis. Clin Res J 2021; 15(3): 336–344. - PubMed
    1. Xie M, Zhu C, Ye Y. Incidence, risk factors, and prognosis of acute exacerbation of rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis. BMC Pulm Med 2023; 23(1): 255. - PMC - PubMed
    1. Kolb M, Bondue B, Pesci A, et al. Acute exacerbations of progressive-fibrosing interstitial lung diseases. Eur Respir Rev 2018; 27(150): 180071. - PMC - PubMed

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