학술논문

Development of the Lung Transplant Frailty Scale (LT-FS).
Document Type
Academic Journal
Author
Singer JP; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA. Electronic address: jon.singer@ucsf.edu.; Christie JD; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA.; Diamond JM; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA.; Anderson MA; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA.; Benvenuto LA; Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, Villanova, Pennsylvania.; Gao Y; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Arcasoy SM; Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, Villanova, Pennsylvania.; Lederer DJ; Regeneron Pharmaceuticals, Tarrytown, New York.; Calabrese D; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA; Medical Service, San Francisco VA Health Care System, San Francisco, California.; Wang P; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Hays SR; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Kukreja J; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Venado A; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Kolaitis NA; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Leard LE; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Shah RJ; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Kleinhenz ME; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Golden J; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Betancourt L; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Oyster M; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA.; Zaleski D; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA.; Adler J; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA.; Kalman L; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA.; Balar P; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, PA, USA.; Patel S; Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Medical Center, Villanova, Pennsylvania.; Medikonda N; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA.; Koons B; College of Nursing, Villanova University, Villanova, PA, USA.; Tevald M; Regeneron Pharmaceuticals, Tarrytown, New York.; Covinsky KE; Division of Geriatrics, Department of Medicine, University of California, San Francisco, California.; Greenland JR; Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, University of California, San Francisco CA, USA; Medical Service, San Francisco VA Health Care System, San Francisco, California.; Katz PK; Division of Rheumatology, Department of Medicine, University of California, San Francisco, California.
Source
Publisher: Elsevier Country of Publication: United States NLM ID: 9102703 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1557-3117 (Electronic) Linking ISSN: 10532498 NLM ISO Abbreviation: J Heart Lung Transplant Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Existing measures of frailty developed in community dwelling older adults may misclassify frailty in lung transplant candidates. We aimed to develop a novel frailty scale for lung transplantation with improved performance characteristics.
Methods: We measured the short physical performance battery (SPPB), fried frailty phenotype (FFP), Body Composition, and serum Biomarkers representative of putative frailty mechanisms. We applied a 4-step established approach (identify frailty domain variable bivariate associations with the outcome of waitlist delisting or death; build models sequentially incorporating variables from each frailty domain cluster; retain variables that improved model performance ability by c-statistic or AIC) to develop 3 candidate "Lung Transplant Frailty Scale (LT-FS)" measures: 1 incorporating readily available clinical data; 1 adding muscle mass, and 1 adding muscle mass and research-grade Biomarkers. We compared construct and predictive validity of LT-FS models to the SPPB and FFP by ANOVA, ANCOVA, and Cox proportional-hazard modeling.
Results: In 342 lung transplant candidates, LT-FS models exhibited superior construct and predictive validity compared to the SPPB and FFP. The addition of muscle mass and Biomarkers improved model performance. Frailty by all measures was associated with waitlist disability, poorer HRQL, and waitlist delisting/death. LT-FS models exhibited stronger associations with waitlist delisting/death than SPPB or FFP (C-statistic range: 0.73-0.78 vs. 0.57 and 0.55 for SPPB and FFP, respectively). Compared to SPPB and FFP, LT-FS models were generally more strongly associated with delisting/death and improved delisting/death net reclassification, with greater improvements with increasing LT-FS model complexity (range: 0.11-0.34). For example, LT-FS-Body Composition hazard ratio for delisting/death: 6.0 (95%CI: 2.5, 14.2), SPPB HR: 2.5 (95%CI: 1.1, 5.8), FFP HR: 4.3 (95%CI: 1.8, 10.1). Pre-transplant LT-FS frailty, but not SPPB or FFP, was associated with mortality after transplant.
Conclusions: The LT-FS is a disease-specific physical frailty measure with face and construct validity that has superior predictive validity over established measures.
(Copyright © 2023 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)