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Longer hospital stay and fewer transplants for frail ILD patients

Presented by
Dr Karan Chohan, University of Toronto, Canada
ERS 2020
Many patients with interstitial lung disease (ILD) suffer from frailty. A retrospective, cohort study assessed the outcome of frail ILD patients compared with patients without frailty after an acute exacerbation of their disease and found that frailty is associated with a longer hospital stay and a reduced likelihood of transplant [1]. 

Frailty is a biological syndrome characterised by a decreased physiological reserve for several stressors, which has been associated with a higher risk of adverse health outcomes. However, the evaluation of frailty in the setting of an acute exacerbation of ILD has not been evaluated until now [2,3]. Yet, identifying frail patients admitted with an ILD exacerbation may help with decision-making in this difficult-to-treat population.

Thus, Dr Karan Chohan (University of Toronto, Canada) and his team set out to explore the prevalence of frailty in admitted ILD patients with acute exacerbations and evaluate its association with length of hospital stay and post-exacerbation 1-year outcomes. The authors hypothesised that frail patients would have a higher likelihood for re-exacerbation and a reduced 1-year transplant-free survival. This retrospective, single-centre cohort study included 106 adult ILD patients admitted to Toronto General Hospital with an ILD exacerbation. ILD patients admitted for other reasons, such as a lung transplant assessment, were not included. At the time of hospital admission, frailty was assessed using a standardised frailty score with an index of ≥0.25 characterising frailty.

Frailty was prevalent and observed in about 40% of acute exacerbations of ILD patients. ILD patients characterised as frail were more likely to have a non-idiopathic pulmonary fibrosis diagnosis, a greater number of comorbidities (assessed in the Charlson Comorbidity Index), and a lower exercise capacity in the 6-minute walking test.

Frail ILD patients had a significantly longer hospital stay (frail vs not frail 3.2 days; 95% CI 0.6-5.4; P=0.03). They were also less likely to be transplanted compared with ILD patients without frailty (see Table). Interestingly, exacerbation rates or all-cause 1-year mortality was not significantly higher compared with ILD patients without frailty.

Table: Post exacerbation 1-year outcomes [1]

*Transplanted (frail vs not-frail): OR 0.15; 95% CI 0.04-0.51; P=0.002, adjusted for age, sex and ILD type.


    1. Chohan K, et al. Clinical Implications of Frailty in Acute Exacerbations of Interstitial Lung Disease. Poster P610. ATS 2020 Virtual, 5-10 Aug.
    2. Kolb M, et al. Eur Resp J 2018;27:180071.
    3. Milne KM, et al. Respirology 2017:22:728-734.


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