Patient-reported symptoms and functioning as indicators of mortality in advanced cystic fibrosis: A new tool for referral and selection for lung transplantation
Section snippets
Study design and population
The Research Ethics Board of the University Hospital la Fe approved this study. A prospective study of HRQoL was conducted in patients with CF either on a waitlist for LTX or not yet waitlisted. The sample included 152 patients who completed the CFQ-R every 3 months along with standard clinical measures. All patients with CF seen in our CF and LTX Unit from January 2010 to January 2015 were eligible for inclusion. Patients were followed from enrollment through the follow-up period (2–4 years).
Results
The study sample included 152 patients with no missing data or loss to follow-up. Baseline demographic characteristics are shown in Table 1. In general, female patients had worse scores than male patients on the following CFQ-R scales: Health Perceptions (p < 0.03), Social Functioning (p < 0.001), and Vitality (p < 0.006), regardless of age or lung function.
Of the 152 patients, 37 (24.34%) were activated on the waiting list for transplant during the study and 15 patients (9.87%) died (12 on the
Discussion
Existing guidelines on specific selection criteria for LTX in patients with CF have been primarily based on single-center data,8 which identified FEV1 <30% predicted as a useful survival marker. Numerous authors have attempted to develop models incorporating several variables to predict long-term survival in larger CF cohorts, but no model is widely used owing to lack of predictive ability. One model based on data from the US Cystic Fibrosis Foundation considered 9 parameters to assess 5-year
Disclosure statement
None of the authors has a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.
This study was supported by a Pablo Motos grant from the Spanish Federation of Cystic Fibrosis and an International Traveling Scholarship from the International Society for Heart and Lung Transplantation (A.S.).
The authors thank all patients who participated in this study, Dr. Vincent Valentine for his initial help
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2022, Journal of Heart and Lung TransplantationCitation Excerpt :Here, we employed the deficit accumulation approach to capture frailty as a multidimensional risk state using existing clinical data. This approach can aid evaluation of interventions, such as LT, that are pleiotropic affecting multiple pathophysiological mechanisms.32 Although frailty has been associated with adverse outcomes in many clinical and population settings, few studies have assessed frailty in LT, with none providing a CF-specific analysis.35
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