Abstract
BACKGROUND: Frailty has emerged as an important prognostic factor in patients with interstitial lung disease (ILD), but its impact on hospitalized ILD patients with acute respiratory deterioration (ARD) remains unclear. The objective of this study is to investigate the association between preadmission frailty and clinical outcomes including 180-day mortality and functional decline in ILD patients hospitalized due to ARD. METHODS: This multicenter prospective study included ILD patients admitted due to ARD at five acute care hospitals in Japan. Frailty was assessed at admission using the Clinical Frailty Scale (CFS) based on patients' prehospitalization condition. The primary outcome was 180-day mortality from the day of admission. Secondary outcomes included early ambulation and functional decline at discharge. Cox regression and logistic regression analyses were used to assess the impact of frailty on outcomes. RESULTS: Among 205 patients, 37 (18.0%) were classified as frail (CFS 5-9). The frail group had significantly higher 180-day mortality than the nonfrail group (p = 0.002). Frailty remained an independent predictor of 180-day mortality after multivariable adjustment (hazard ratio 2.450, 95% confidence interval [CI]1.327-4.524, p = 0.004). Nonfrailty was an independent predictor of early ambulation (odds ratio [OR] 4.820, 95% CI 1.700-13.600, p = 0.003); however, it was not a significant predictor of functional decline (OR 1.810, 95% CI 0.748-4.380, p = 0.188). CONCLUSIONS: Frailty independently predicted mortality and adverse functional outcomes in ILD patients hospitalized due to ARD. Frailty assessment on admission may help identify patients who require early and tailored multidisciplinary interventions.