Abstract
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.
Abstract
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
Footnotes
This article has been revised according to the correction published in the March 2020 issue of the European Respiratory Journal.
This article has an editorial commentary: https://doi.org/13993003.02255-2019
This article has supplementary material available from erj.ersjournals.com
Author contributions: C.J. Ryerson takes responsibility for the content of the manuscript, including the data and analysis and is guarantor of this paper. S.A. Guler and C.J. Ryerson contributed to the conception and design of the study, and acquisition, analysis and interpretation of the data. J.M. Kwan, J.M. Leung, N. Khalil and P.G. Wilcox contributed to the acquisition and interpretation of the data. All authors revised the manuscript for important intellectual content and provided final approval of the version to be published.
Support statement: This study was co-funded by the British Columbia Lung Association and InterMune/Hoffmann-La Roche Inc. Neither sponsor had input into the study design, analysis, interpretation of results, or the presentation of findings. Funding information for this article has been deposited with the Crossref Funder Registry.
Conflict of interest: S.A. Guler has nothing to disclose.
Conflict of interest: J.M. Kwan has nothing to disclose.
Conflict of interest: J.M. Leung has nothing to disclose.
Conflict of interest: N. Khalil has nothing to disclose.
Conflict of interest: P.G. Wilcox has nothing to disclose.
Conflict of interest: C.J. Ryerson has nothing to disclose.
- Received March 30, 2019.
- Accepted September 1, 2019.
- Copyright ©ERS 2020