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Background <p>Acute exacerbations (AE) of fibrotic interstitial lung disease (fILD) are associated with a poor prognosis; however, the factors that predict long-term outcomes remain unclear. This study aimed to evaluate whether pre-admission frailty, as assessed using the Clinical Frailty Scale (CFS), predicts 1-year mortality and other relevant outcomes in patients with AE-fILD.</p> Methods <p>This single-centre retrospective study included 125 patients hospitalised for AE-fILD between January 2017 and September 2023. Patients were categorised into low (score: 1–4) and high (score: 5–9) CFS groups based on their CFS scores. The primary outcome was 1-year mortality, and the secondary outcomes included in-hospital mortality, 90-day mortality, and home discharge. Prognostic associations were evaluated using Kaplan–Meier and multivariable Cox regression analyses, adjusted for age, lactate dehydrogenase levels, SpO₂/F<sub>I</sub>O₂ ratio, and home oxygen therapy.</p> Results <p>The median patient age was 78 years, and 41.6% of patients were included in the high CFS group. Kaplan–Meier analysis revealed a significantly lower 1-year survival in the high-CFS group (log-rank, <i>p</i> &lt; 0.001). After adjustment, a high CFS score remained independently associated with increased 1-year mortality (adjusted hazard ratio, 2.20; 95% confidence interval, 1.31–3.68; <i>p</i> = 0.003). Higher in-hospital and 90-day mortality rates and lower home discharge rates were observed in the frail subgroup.</p> Conclusion <p>Preadmission frailty, as assessed using the CFS, independently predicts 1-year mortality and is associated with adverse outcomes in patients with AE-fILD. Incorporating a CFS-based frailty assessment may provide a simple and useful prognostic tool to inform clinical decision-making and promote patient-centred care.</p> Trial registration <p>An independent ethics committee approved the study (Institutional Review Board of the Kobe City Medical Center General Hospital [number zn241009 date October 8, 2024]), which was performed in accordance with the Declaration of Helsinki and Guidelines for Good Clinical Practice.</p>

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Long-term prognostic impact of clinical frailty scale on acute exacerbation of fibrotic interstitial lung disease: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年5月7日

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  • Shoichiro Saito,
  • Chigusa Shirakawa,
  • Kanji Yamada,
  • Jumpei Harada,
  • Kyosuke Wakata,
  • Tsuyoshi Sasada,
  • Shohei Aoki,
  • Yuya Nishida,
  • Kentaro Iwata,
  • Ryosuke Hirabayashi,
  • Atsushi Nakagawa,
  • Kazuma Nagata,
  • Yuki Sato,
  • Keisuke Tomii,
  • Ryo Tachikawa

摘要

Background

Acute exacerbations (AE) of fibrotic interstitial lung disease (fILD) are associated with a poor prognosis; however, the factors that predict long-term outcomes remain unclear. This study aimed to evaluate whether pre-admission frailty, as assessed using the Clinical Frailty Scale (CFS), predicts 1-year mortality and other relevant outcomes in patients with AE-fILD.

Methods

This single-centre retrospective study included 125 patients hospitalised for AE-fILD between January 2017 and September 2023. Patients were categorised into low (score: 1–4) and high (score: 5–9) CFS groups based on their CFS scores. The primary outcome was 1-year mortality, and the secondary outcomes included in-hospital mortality, 90-day mortality, and home discharge. Prognostic associations were evaluated using Kaplan–Meier and multivariable Cox regression analyses, adjusted for age, lactate dehydrogenase levels, SpO₂/FIO₂ ratio, and home oxygen therapy.

Results

The median patient age was 78 years, and 41.6% of patients were included in the high CFS group. Kaplan–Meier analysis revealed a significantly lower 1-year survival in the high-CFS group (log-rank, p < 0.001). After adjustment, a high CFS score remained independently associated with increased 1-year mortality (adjusted hazard ratio, 2.20; 95% confidence interval, 1.31–3.68; p = 0.003). Higher in-hospital and 90-day mortality rates and lower home discharge rates were observed in the frail subgroup.

Conclusion

Preadmission frailty, as assessed using the CFS, independently predicts 1-year mortality and is associated with adverse outcomes in patients with AE-fILD. Incorporating a CFS-based frailty assessment may provide a simple and useful prognostic tool to inform clinical decision-making and promote patient-centred care.

Trial registration

An independent ethics committee approved the study (Institutional Review Board of the Kobe City Medical Center General Hospital [number zn241009 date October 8, 2024]), which was performed in accordance with the Declaration of Helsinki and Guidelines for Good Clinical Practice.