Combined Assessment of Frailty and Respiratory Function in Idiopathic Pulmonary Fibrosis: A Prospective Cohort Study.

IF 8.7 3区医学 Q1 RESPIRATORY SYSTEM

Archivos De Bronconeumologia Pub Date : 2026-08-13 DOI:10.1016/j.arbres.2026.07.002

Chukwuma Okoye, Giovanni Franco, Isabella Ceravolo, Umberto Zanini, Riccardo Galluccio, Alice Margherita Ornago, Elisa Perger, Maria Cristina Ferrara, Camilla Tocci, Leonardo Barbieri, Alberto Finazzi, Paola Faverio, Antonella Zambon, Fabrizio Luppi, Giuseppe Bellelli

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引用次数: 0

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) predominantly affects older adults. Frailty is increasingly recognized as an important feature of IPF, although its prognostic value remains uncertain. This study aimed to assess the prevalence of frailty and concordance among validated instruments, characterize the principal domains of vulnerability identified through comprehensive geriatric assessment (CGA), and evaluate the prognostic value of integrating frailty with indices of respiratory disease severity in older adults with IPF.

Methods: We conducted a prospective, single-center study of patients aged 65 years or older with confirmed IPF. Frailty was assessed using the Fried frailty phenotype (FFP), a CGA-derived Frailty Index (CGA-FI), and the Clinical Frailty Scale (CFS). The primary outcome was a composite of all-cause mortality or acute exacerbation during follow-up. Cox proportional hazards models and bootstrap-derived concordance indices were used to evaluate prognostic associations and model discrimination.

Results: Among the 140 patients included, the prevalence of frailty ranged from 16.4% according to the CGA-FI to 22.3% according to the FFP, whereas 19.3% were classified as frail according to the CFS. During a median follow-up of 465 days (IQR, 221-1076 days), 35 patients (25.0%) experienced the composite outcome. Frailty assessed using the CFS (CFS ≥5: HR, 3.94; 95%CI, 1.81-8.58) and a higher Gender-Age-Physiology (GAP) stage (GAP II-III: HR, 3.11; 95%CI, 1.39-7.00) were independently associated with the composite outcome. The integrated GAP-CFS model showed good discrimination, with a bootstrap-derived Harrell C index of 0.72 (95%CI, 0.62-0.81). Patients who experienced events also had higher Strength, Assistance in Walking, Rising From a Chair, Climbing Stairs, and Falls (SARC-F) scores and greater functional impairment.

Conclusions: Frailty is common and clinically relevant in IPF. Integrating frailty measures with pulmonary indices improves prognostic stratification and supports the use of the CFS and CGA to guide personalized, multidimensional care.

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特发性肺纤维化患者虚弱和呼吸功能的综合评估：一项前瞻性队列研究。

背景：特发性肺纤维化（IPF）主要影响老年人。尽管其预后价值仍不确定，但虚弱已日益被认为是指间因子的一个重要特征。本研究旨在评估虚弱的患病率和验证工具之间的一致性，表征通过综合老年评估（CGA）确定的主要易感领域，并评估将虚弱与呼吸道疾病严重程度指标相结合的老年IPF患者的预后价值。方法：我们对确诊IPF的65岁及以上患者进行了一项前瞻性单中心研究。使用Fried衰弱表型（FFP）、cga衍生的衰弱指数（CGA-FI）和临床衰弱量表（CFS）评估衰弱。主要结局是随访期间全因死亡率或急性加重的综合结果。使用Cox比例风险模型和自举衍生的一致性指数来评估预后关联和模型判别。结果：在纳入的140例患者中，根据CGA-FI，虚弱的患病率为16.4%，根据FFP为22.3%，而根据CFS，虚弱的患病率为19.3%。在中位随访465天（IQR， 221-1076天）期间，35例患者（25.0%）出现复合结局。使用CFS评估的虚弱（CFS≥5:HR, 3.94; 95%CI, 1.81-8.58）和较高的性别-年龄-生理（GAP）阶段（GAP II-III: HR, 3.11; 95%CI, 1.39-7.00）与综合结果独立相关。综合GAP-CFS模型具有良好的判别能力，其Harrell C指数为0.72 （95%CI, 0.62-0.81）。经历过这些事件的患者也有更高的力量、行走辅助、从椅子上站起来、爬楼梯和跌倒（SARC-F）评分和更大的功能损害。结论：虚弱在IPF中是常见的，且与临床相关。将衰弱指标与肺指数相结合可改善预后分层，并支持使用CFS和CGA来指导个性化、多维护理。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Archivos De Bronconeumologia Medicine-Pulmonary and Respiratory Medicine

CiteScore

3.50

自引率

17.50%

发文量

330

审稿时长

14 days

期刊介绍： Archivos de Bronconeumologia is a scientific journal that specializes in publishing prospective original research articles focusing on various aspects of respiratory diseases, including epidemiology, pathophysiology, clinical practice, surgery, and basic investigation. Additionally, the journal features other types of articles such as reviews, editorials, special articles of interest to the society and editorial board, scientific letters, letters to the editor, and clinical images. Published monthly, the journal comprises 12 regular issues along with occasional supplements containing articles from different sections. All manuscripts submitted to the journal undergo rigorous evaluation by the editors and are subjected to expert peer review. The editorial team, led by the Editor and/or an Associate Editor, manages the peer-review process. Archivos de Bronconeumologia is published monthly in English, facilitating broad dissemination of the latest research findings in the field.