Frailty predicts outcomes in cystic fibrosis patients listed for lung transplantation,The Journal of Heart and Lung Transplantation

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Frailty predicts outcomes in cystic fibrosis patients listed for lung transplantation
The Journal of Heart and Lung Transplantation ( IF 8.9 ) Pub Date : 2022-07-24 , DOI: 10.1016/j.healun.2022.07.017
Angela Koutsokera ₁ , Jenna Sykes ₂ , Olga Theou ₃ , Kenneth Rockwood ₄ , Carolin Steinack ₅ , Marie-France Derkenne ₆ , Christian Benden ₇ , Thorsten Krueger ₈ , Cecilia Chaparro ₉ , John-David Aubert ₁₀ , Paola Soccal Gasche ₁₁ , Christophe von Garnier ₆ , Elizabeth Tullis ₁₂ , Anne L Stephenson ₁₂ , Lianne G Singer ₁₃

Affiliation

Division of Respiratory Medicine, Center of Lung Transplantation, Center of Adult Cystic Fibrosis and CFTR-related disorders, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Division of Respirology, Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of Respirology, Adult Cystic Fibrosis Centre, St. Michael's Hospital, Toronto, ON, Canada.
Division of Respirology, Adult Cystic Fibrosis Centre, St. Michael's Hospital, Toronto, ON, Canada.
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
Division of Respiratory Medicine, Center of Lung Transplantation, Center of Adult Cystic Fibrosis and CFTR-related disorders, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Medical Faculty, University of Zurich, Zurich, Switzerland.
Division of Thoracic Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Division of Respirology, Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada; Division of Respirology, Adult Cystic Fibrosis Centre, St. Michael's Hospital, Toronto, ON, Canada.
Division of Respiratory Medicine, Center of Lung Transplantation, Center of Adult Cystic Fibrosis and CFTR-related disorders, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Center of Organ Transplantation, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Division of Respiratory Medicine, Geneva University Hospitals, Geneva, Switzerland.
Division of Respirology, Adult Cystic Fibrosis Centre, St. Michael's Hospital, Toronto, ON, Canada; Keenan Research Center, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
Division of Respirology, Lung Transplant Program, Toronto General Hospital, University Health Network, Toronto, ON, Canada.

Background

Survival predictors are not established for cystic fibrosis (CF) patients listed for lung transplantation (LT). Using the deficit accumulation approach, we developed a CF-specific frailty index (FI) to allow risk stratification for adverse waitlist and post-LT outcomes.

Methods

We studied adult CF patients listed for LT in the Toronto LT Program (development cohort 2005-2015) and the Swiss LT centres (validation cohort 2008-2017). Comorbidities, treatment, laboratory results and social support at listing were utilized to develop a lung disease severity index (LI deficits, d = 18), a frailty index (FI, d = 66) and a lifestyle/social vulnerability index (LSVI, d = 10). We evaluated associations of the indices with worsening waitlist status, hospital and ICU length of stay, survival and graft failure.

Results

We studied 188 (Toronto cohort, 176 [94%] transplanted) and 94 (Swiss cohort, 89 [95%] transplanted) patients. The median waitlist times were 69 and 284 days, respectively. The median follow-up post-transplant was 5.3 and 4.7 years. At listing, 44.7% of patients were frail (FI ≥ 0.25) in the Toronto and 21.3% in the Swiss cohort. The FI was significantly associated with all studied outcomes in the Toronto cohort (FI and post-LT mortality, multivariable HR 1.74 [95%CI:1.24-2.45] per 0.1 point of the FI). In the Swiss cohort, the FI was associated with worsening waitlist status, post-LT mortality and graft failure.

Conclusions

In CF patients listed for LT, FI risk stratification was significantly associated with waitlist and post-LT outcomes. Studying frailty in young populations with advanced disease can provide insights on how frailty and deficit accumulation impacts survival.

中文翻译：

虚弱可预测列入肺移植名单的囊性纤维化患者的结果

背景

对于列入肺移植 (LT) 的囊性纤维化 (CF) 患者，尚未确定生存预测因子。使用赤字累积方法，我们开发了一个特定于 CF 的衰弱指数 (FI)，以允许对不利的候补名单和 LT 后结果进行风险分层。

方法

我们研究了多伦多 LT 计划（2005-2015 年发展队列）和瑞士 LT 中心（2008-2017 年验证队列）中列入 LT 的成年 CF 患者。列出的合并症、治疗、实验室结果和社会支持被用来制定肺部疾病严重程度指数（LI 缺陷，d = 18）、虚弱指数（FI，d = 66）和生活方式/社会脆弱性指数（LSVI，d = 10)。我们评估了这些指数与候补名单恶化、住院和 ICU 住院时间、存活率和移植失败的关联。

结果

我们研究了 188 名（多伦多队列，176 名 [94%] 移植）和 94 名（瑞士队列，89 名 [95%] 移植）患者。候补时间中位数分别为 69 天和 284 天。移植后的中位随访时间为 5.3 年和 4.7 年。上市时，多伦多有 44.7% 的患者身体虚弱（FI ≥ 0.25），瑞士队列有 21.3% 的患者。FI 与多伦多队列中的所有研究结果显着相关（FI 和 LT 后死亡率，多变量 HR 1.74 [95%CI:1.24-2.45] 每 0.1 个 FI 点）。在瑞士队列中，FI 与候补状态恶化、LT 后死亡率和移植失败有关。