背景:目前尚无关于胸膜疾病的虚弱与死亡率之间关系的数据。了解虚弱与结果之间的关系对于临床医生指导有关调查和管理的决策越来越重要。本研究旨在探讨胸膜疾病患者全因死亡率与虚弱状态之间的关系。
方法:在这项前瞻性收集的观察性队列研究的回顾性分析中,在布里斯托尔三级中心接受胸膜服务的门诊患者,英国有放射学证实,未确诊的胸腔积液接受全面评估,并在12个月时被分配为最终诊断.计算修正的虚弱指数(mFI),参与者分为虚弱(mFI≥0.4)或不虚弱(mFI≤0.2)。
结果:从2008年3月3日至2020年12月29日纳入676名参与者。中位死亡时间为490天(IQR161-1595)。12个月死亡率和虚弱(aHR=1.72,95%CI1.02-2.76,p=0.025)与年龄≥80(aHR=1.80,95%CI1.24-2.62,p=0.002)之间呈正相关。亚组分析发现良性疾病12个月死亡率和虚弱之间的相关性更强(aHR=4.36,95%CI2.17-8.77,p<0.0001)。与虚弱状态无关的恶性肿瘤与全因死亡率增加相关(aHR=10.40,95%CI6.01-18.01,p<0.0001)。
结论:这是第一项评估胸膜疾病虚弱与预后之间关系的研究。我们的数据表明,在这个队列中,虚弱和12个月死亡率之间有很强的关联。恶性诊断是12个月死亡率的独立预测因素,不管脆弱的状态。在良性胸膜疾病的患者中,虚弱也与12个月的死亡率密切相关。这对胸膜医师具有临床意义;评估患者的虚弱状态及其对死亡率的影响可以指导临床医师评估侵入性调查和管理的适用性。
背景:本研究已在健康研究机构(REC参考08/H0102/11)和NIHR投资组合(研究ID8960)注册。
BACKGROUND: There are currently no data on the relationship between frailty and mortality in pleural disease. Understanding the relationship between frailty and outcomes is increasingly important for clinicians to guide decisions regarding investigation and management. This study aims to explore the relationship between all-cause mortality and frailty status in patients with pleural disease.
METHODS: In this retrospective analysis of a prospectively collected observational cohort study, outpatients presenting to the pleural service at a tertiary centre in Bristol, UK with a radiologically confirmed, undiagnosed pleural effusion underwent comprehensive assessment and were assigned a final diagnosis at 12 months. The modified frailty index (mFI) was calculated and participants classified as frail (mFI ≥ 0.4) or not frail (mFI ≤ 0.2).
RESULTS: 676 participants were included from 3rd March 2008 to 29th December 2020. The median time to mortality was 490 days (IQR 161-1595). A positive association was found between 12-month mortality and frailty (aHR = 1.72, 95% CI 1.02-2.76, p = 0.025) and age ≥ 80 (aHR = 1.80, 95% CI 1.24-2.62, p = 0.002). Subgroup analyses found a stronger association between 12-month mortality and frailty in benign disease (aHR = 4.36, 95% CI 2.17-8.77, p < 0.0001) than in all pleural disease. Malignancy irrespective of frailty status was associated with an increase in all-cause mortality (aHR = 10.40, 95% CI 6.01-18.01, p < 0.0001).
CONCLUSIONS: This is the first study evaluating the relationship between frailty and outcomes in pleural disease. Our data demonstrates a strong association between frailty and 12-month mortality in this cohort. A malignant diagnosis is an independent predictor of 12-month mortality, irrespective of frailty status. Frailty was also strongly associated with 12-month mortality in patients with a benign underlying cause for their pleural disease. This has clinical relevance for pleural physicians; evaluating patients\' frailty status and its impact on mortality can guide clinicians in assessing suitability for invasive investigation and management.
BACKGROUND: This study is registered with the Health Research Authority (REC reference 08/H0102/11) and the NIHR Portfolio (Study ID 8960).