Table 2_Frailty and functional outcomes in patients with progressive fibrosing interstitial lung diseases receiving antifibrotic therapy: a real-life observational study.docx

ObjectivesTreatment of idiopathic pulmonary fibrosis (IPF) and progressive fibrosing interstitial lung disease (PF-ILD) remain challenging in elderly patients with frailty, which negatively impact outcomes. This study aims at describing the prevalence of frailty in a cohort of patients with PF-ILD on antifibrotic therapy and to investigate its potential impact on treatment effectiveness and tolerability.
MethodsThis monocentric, retrospective study enrolled a total of 64 patients with either IPF or other progressive pulmonary fibrosis (PPF) treated with antifibrotic treatment at our center between June 2022 and November 2023. The frailty status of patients with ILD was measured using the Clinical Frailty Scale (CFS). Baseline data were used to classify patients into two groups according to CFS: (1) non-frail patients with CFS < 5 or (2) frail patients with CFS ≥ 5.
ResultsThe mean CFS score in the overall population was 5.02 ± 1.62. Thirty-seven (58%) were frail while 27 (42%) met criteria for no-frailty. Frail patients, compared to non-frail, were older (74.4 ± 4.66 vs. 70.6 ± 4.78, p = 0.004), and had significantly lower FVC (L) (2.31 ± 0.75 L vs. 2.78 ± 0.75 L, p = 0.03), percent predicted DLco (%DLco) (43.47 ± 13.52 vs. 54.6 ± 11.48, p = 0.003) and lower 6-min walk distance (6MWD) (305 ± 159 vs. 410 ± 94, p = 0.006) compared to no-frail patients at baseline. Frail patients had higher ILD-GAP index (4.62 ± 1.41 vs. 3.88 ± 1.18, p = 0.037) compared to non-frail patients. Interestingly, functional trajectories decline was not significantly different between frail and no-frail patients. Regarding safety profile, medication dose reduction due to adverse events was greater in frail patients (51.3% vs. 26%, p = 0.04) while not significant differences emerged in side effects.
ConclusionFrailty has been associated with poorer lung function and greater physical impairment in patients with fibrotic ILDs under antifibrotic treatment. Frail patients also more frequently require medication dose reduction due to adverse effects.

【研究目的】对于合并衰弱的老年患者，特发性肺纤维化（idiopathic pulmonary fibrosis, IPF）与进行性纤维化性间质性肺疾病（progressive fibrosing interstitial lung disease, PF-ILD）的治疗仍具挑战性，且会对患者预后产生不良影响。本研究旨在描述接受抗纤维化治疗的PF-ILD患者队列中衰弱的患病率，并探究衰弱对治疗有效性与耐受性的潜在影响。

【研究方法】本研究为单中心回顾性研究，纳入2022年6月至2023年11月期间于本中心接受抗纤维化治疗的64例IPF或其他进展性肺纤维化（progressive pulmonary fibrosis, PPF）患者。采用临床衰弱量表（Clinical Frailty Scale, CFS）评估间质性肺疾病患者的衰弱状态，以基线数据结合CFS评分将患者分为两组：（1）非衰弱组：CFS评分<5；（2）衰弱组：CFS评分≥5。

【研究结果】整体人群的平均CFS评分为5.02±1.62。其中37例（58%）符合衰弱诊断标准，27例（42%）符合非衰弱诊断标准。与非衰弱患者相比，衰弱患者年龄更大（74.4±4.66 vs 70.6±4.78，p=0.004），基线时用力肺活量（forced vital capacity, FVC）（2.31±0.75 L vs 2.78±0.75 L，p=0.03）、肺一氧化碳弥散量占预计值百分比（%DLco）（43.47±13.52 vs 54.6±11.48，p=0.003）及6分钟步行距离（6-minute walk distance, 6MWD）（305±159 vs 410±94，p=0.006）均显著更低。衰弱患者的间质性肺疾病-GAP指数（ILD-GAP index）显著高于非衰弱患者（4.62±1.41 vs 3.88±1.18，p=0.037）。值得注意的是，衰弱与非衰弱患者的功能减退轨迹无显著差异。在安全性方面，衰弱患者因不良事件需药物减量的比例更高（51.3% vs 26%，p=0.04），但两组间不良反应发生率无显著差异。

【研究结论】接受抗纤维化治疗的纤维化性间质性肺疾病患者中，衰弱与更差的肺功能及更严重的躯体功能受损相关。此外，衰弱患者因不良反应需调整药物剂量的频率更高。