Background Accelerated biological and functional ageing is common in fibrotic interstitial lung disease (ILD); however, their impact on adverse health outcomes has not been evaluated in this population. Methods Patients were prospectively recruited from a specialised ILD clinic. Functional ageing was determined by frailty index and biological age by measurement of absolute telomere length (aTL) from patients' peripheral blood leukocytes. Adverse health outcomes included health-related quality of life (St George's Respiratory Questionnaire), number and length of respiratory and non-respiratory hospitalisations, medication tolerability and time to death or lung transplantation. Multivariable models were used to determine the risks and rates of adverse health outcomes associated with the frailty index and aTL. Results 540 patients with fibrotic ILD, including 100 with idiopathic pulmonary fibrosis (IPF), provided 749 frailty index assessments, with 189 patients providing blood samples. The frailty index was strongly associated with quality of life, rate of hospitalisation, time to hospital discharge and mortality, including adjustment for age, sex, disease severity and IPF diagnosis. Mortality prognostication was improved by the addition of the frailty index to commonly used clinical parameters and previously validated composite indices. Conversely, aTL was not associated with most adverse health outcomes. The effect of chronological age on outcomes was mediated primarily by the frailty index, and to a lesser extent by aTL. Conclusions Functional ageing is associated with adverse health outcomes in patients with fibrotic ILD, indicating the need for consideration of the individual functional age into clinical decision-making. Frailty independently predicts adverse health outcomes in patients with fibrotic ILD; with functional ageing as the main driver of most age-related adverse health outcomes there is a need to recognise, prevent and treat frailty in this population http://bit.ly/2k81rRc

中文翻译：

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纤维化间质性肺病的功能性衰老：虚弱对不良健康结果的影响

背景 在纤维化间质性肺病 (ILD) 中，生物和功能性衰老加速；然而，尚未在该人群中评估它们对不良健康结果的影响。方法 患者是从专门的 ILD 诊所前瞻性招募的。通过测量患者外周血白细胞的绝对端粒长度 (aTL)，通过衰弱指数和生物学年龄确定功能性衰老。不良健康结果包括与健康相关的生活质量（圣乔治呼吸问卷）、呼吸和非呼吸住院的次数和时间、药物耐受性和死亡时间或肺移植。多变量模型用于确定与虚弱指数和 aTL 相关的不良健康结果的风险和发生率。结果 540 名纤维化 ILD 患者，包括 100 名特发性肺纤维化 (IPF) 患者，提供了 749 项虚弱指数评估，其中 189 名患者提供了血液样本。虚弱指数与生活质量、住院率、出院时间和死亡率密切相关，包括对年龄、性别、疾病严重程度和 IPF 诊断的调整。通过将衰弱指数添加到常用的临床参数和先前验证的复合指数中，改善了死亡率预测。相反，aTL 与大多数不良健康结果无关。实际年龄对结果的影响主要由衰弱指数介导，在较小程度上由 aTL 介导。结论 功能性衰老与纤维化 ILD 患者的不良健康结局相关，表明需要在临床决策中考虑个体功能年龄。虚弱独立预测纤维化 ILD 患者的不良健康结果；由于功能性衰老是大多数与年龄相关的不良健康结果的主要驱动因素，因此需要识别、预防和治疗这一人群的虚弱 http://bit.ly/2k81rRc