Physical frailty predicts death in ILD patients

Patients with interstitial lung disease (ILD) are likely to develop physical frailty, which is independently associated with an increased risk of death, reports a study.

“Physical frailty is associated with increased mortality and hospitalizations in older adults,” said the authors, who assessed the prevalence of physical frailty and its prognostic effect in those with a spectrum of fibrotic ILD in this study.

The authors prospectively followed fibrotic ILD patients at the McMaster University ILD programme from November 2015 to March 2020. They used baseline data to classify participants as nonfrail (score=0), prefrail (score=1–2), or frail (score=3–5) based on modified Fried physical frailty criteria.

Time-to-event models were used to examine the relationship between physical frailty and mortality, adjusting for age, sex, lung function, and diagnosis using the ILD Gender–Age–Physiology (ILD-GAP) score.

Of the 463 patients (mean age 68 years, 55 percent male) included, 82 (18 percent) were nonfrail, 258 (56 percent) were prefrail, and 123 (26 percent) were frail.

Idiopathic pulmonary fibrosis was the most common ILD diagnosis (n=183; 40 percent), followed by connective tissue disease-related ILD (n=79; 17 percent). Mean time since diagnosis was 2.7±4.6 years.

Fifty-six deaths occurred within a median follow-up of 1.71 (interquartile range, 1.24–2.31) years. Frail and prefrail patients were at greater risk of mortality than those categorized as nonfrail at baseline (prefrail: adjusted hazard ratio [aHR], 4.14, 95 percent confidence interval [CI], 1.27–13.5; frail: aHR, 4.41, 95 percent CI, 1.29–15.1).

“Assessment of physical frailty provides additional prognostic value to recognized risk scores such as the ILD-GAP score and may present a modifiable target for intervention,” the authors said.