{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T23:25:20Z","timestamp":1793057120889,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>There are currently no data on the relationship between frailty and mortality in pleural disease. Understanding the relationship between frailty and outcomes is increasingly important for clinicians to guide decisions regarding investigation and management. This study aims to explore the relationship between all-cause mortality and frailty status in patients with pleural disease.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>In this retrospective analysis of a prospectively collected observational cohort study, outpatients presenting to the pleural service at a tertiary centre in Bristol, UK with a radiologically confirmed, undiagnosed pleural effusion underwent comprehensive assessment and were assigned a final diagnosis at 12 months. The modified frailty index (mFI) was calculated and participants classified as frail (mFI\u2009<jats:underline>\u2265<\/jats:underline>\u20090.4) or not frail (mFI\u2009<jats:underline>\u2264<\/jats:underline>\u20090.2).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>676 participants were included from 3rd March 2008 to 29th December 2020. The median time to mortality was 490 days (IQR 161\u20131595). A positive association was found between 12-month mortality and frailty (aHR\u2009=\u20091.72, 95% CI 1.02\u20132.76, <jats:italic>p<\/jats:italic>\u2009=\u20090.025) and age\u2009<jats:underline>\u2265<\/jats:underline>\u200980 (aHR\u2009=\u20091.80, 95% CI 1.24\u20132.62, <jats:italic>p<\/jats:italic>\u2009=\u20090.002). Subgroup analyses found a stronger association between 12-month mortality and frailty in benign disease (aHR\u2009=\u20094.36, 95% CI 2.17\u20138.77, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001) than in all pleural disease. Malignancy irrespective of frailty status was associated with an increase in all-cause mortality (aHR\u2009=\u200910.40, 95% CI 6.01\u201318.01, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This is the first study evaluating the relationship between frailty and outcomes in pleural disease. Our data demonstrates a strong association between frailty and 12-month mortality in this cohort. A malignant diagnosis is an independent predictor of 12-month mortality, irrespective of frailty status. Frailty was also strongly associated with 12-month mortality in patients with a benign underlying cause for their pleural disease. This has clinical relevance for pleural physicians; evaluating patients\u2019 frailty status and its impact on mortality can guide clinicians in assessing suitability for invasive investigation and management.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>This study is registered with the Health Research Authority (REC reference 08\/H0102\/11) and the NIHR Portfolio (Study ID 8960).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12890-024-02981-3","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T07:03:56Z","timestamp":1713251036000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The association between frailty and survival in patients with pleural disease: a retrospective cohort study"],"prefix":"10.1186","volume":"24","author":[{"given":"Eleanor","family":"Barton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Verduri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Carter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hughes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Hewitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. A.","family":"Maskell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,16]]},"reference":[{"key":"2981_CR1","doi-asserted-by":"publisher","first-page":"752","DOI":"10.1016\/S0140-6736(12)62167-9","volume":"381","author":"A Clegg","year":"2013","unstructured":"Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381:752\u201362.","journal-title":"Lancet"},{"key":"2981_CR2","doi-asserted-by":"publisher","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","volume":"56","author":"LP Fried","year":"2001","unstructured":"Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA. Cardiovascular Health Study Collaborative Research G. Frailty in older adults: evidence for a phenotype. J Gerontol Biol Sci Med Sci. 2001;56:M146\u201356.","journal-title":"J Gerontol Biol Sci Med Sci"},{"key":"2981_CR3","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1100\/tsw.2001.58","volume":"1","author":"AB Mitnitski","year":"2001","unstructured":"Mitnitski AB, Mogilner AJ, Rockwood K. Accumulation of deficits as a proxy measure of aging. ScientificWorldJournal. 2001;1:323\u201336.","journal-title":"ScientificWorldJournal"},{"key":"2981_CR4","doi-asserted-by":"publisher","first-page":"1929","DOI":"10.1111\/j.1532-5415.2004.52521.x","volume":"52","author":"DM Jones","year":"2004","unstructured":"Jones DM, Song X, Rockwood K. Operationalizing a Frailty Index from a standardized Comprehensive Geriatric Assessment. J Am Geriatr Soc. 2004;52:1929\u201333.","journal-title":"J Am Geriatr Soc"},{"key":"2981_CR5","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1161\/CIRCULATIONAHA.108.841437","volume":"121","author":"DH Lee","year":"2010","unstructured":"Lee DH, Buth KJ, Martin B-J, Yip AM, Hirsch GM. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010;121:973\u20138.","journal-title":"Circulation"},{"key":"2981_CR6","doi-asserted-by":"publisher","first-page":"1526","DOI":"10.1097\/TA.0b013e3182542fab","volume":"72","author":"JS Farhat","year":"2012","unstructured":"Farhat JS, Velanovich V, Falvo AJ, Horst HM, Swartz A, Patton JH, Rubinfeld IS. Are the frail destined to fail? Frailty index as predictor of surgical morbidity and mortality in the elderly. J Trauma Acute Care Surg. 2012;72:1526\u201331.","journal-title":"J Trauma Acute Care Surg"},{"key":"2981_CR7","doi-asserted-by":"publisher","first-page":"87","DOI":"10.3390\/geriatrics7050087","volume":"7","author":"B Carter","year":"2022","unstructured":"Carter B, Keevil VL, Anand A, Osuafor CN, Goudie RJB, Preller J, Lowry M, Clunie S, Shenkin SD, McCarthy K, Hewitt J, Quinn TJ. The prognostic and discriminatory utility of the clinical Frailty Scale and modified Frailty Index compared to age. Geriatrics. 2022;7:87.","journal-title":"Geriatrics"},{"key":"2981_CR8","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1093\/ageing\/afx162","volume":"47","author":"G Kojima","year":"2018","unstructured":"Kojima G, Iliffe S, Walters K. Frailty index as a predictor of mortality: a systematic review and meta-analysis. Age Ageing. 2018;47:193\u2013200.","journal-title":"Age Ageing"},{"key":"2981_CR9","doi-asserted-by":"crossref","unstructured":"Verduri A, Carter B, Rice C, Laraman J, Barton E, Clini E, Maskell NA, Hewitt J. Frailty Prevalence and Association with Clinical outcomes in interstitial lung Disease, Asthma, and Pleural Disease. Geriatr (Basel). 2023; 8.","DOI":"10.3390\/geriatrics8040082"},{"key":"2981_CR10","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.jamcollsurg.2017.11.005","volume":"226","author":"S Subramaniam","year":"2018","unstructured":"Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-Factor modified Frailty Index using American College of Surgeons NSQIP Data. J Am Coll Surg. 2018;226:173\u2013e818.","journal-title":"J Am Coll Surg"},{"key":"2981_CR11","doi-asserted-by":"publisher","first-page":"e626","DOI":"10.1016\/j.wneu.2018.12.168","volume":"124","author":"DJ Weaver","year":"2019","unstructured":"Weaver DJ, Malik AT, Jain N, Yu E, Kim J, Khan SN. The modified 5-Item Frailty Index: a concise and useful Tool for assessing the impact of Frailty on postoperative morbidity following elective posterior lumbar fusions. World Neurosurg. 2019;124:e626\u201332.","journal-title":"World Neurosurg"},{"key":"2981_CR12","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1136\/ijgc-2022-004175","volume":"33","author":"MD Levine","year":"2023","unstructured":"Levine MD, Felix AS, Meade CE, Bixel KL, Chambers LM. The modified 5-item frailty index is a predictor of post-operative complications in vulvar cancer: a National Surgical Quality Improvement Program (NSQIP) analysis. Int J Gynecol Cancer. 2023;33:465\u201372.","journal-title":"Int J Gynecol Cancer"},{"key":"2981_CR13","doi-asserted-by":"publisher","first-page":"1055","DOI":"10.1016\/j.mcna.2011.08.005","volume":"95","author":"RW Light","year":"2011","unstructured":"Light RW. Pleural effusions. Med Clin N Am. 2011;95:1055\u201370.","journal-title":"Med Clin N Am"},{"key":"2981_CR14","first-page":"161","volume":"50","author":"JM Porcel","year":"2014","unstructured":"Porcel JM, Esquerda A, Vives M, Bielsa S. Etiology of Pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Archivos De Bronconeumolog\u00eda. (English Edition). 2014;50:161\u20135.","journal-title":"(English Edition)"},{"key":"2981_CR15","doi-asserted-by":"publisher","first-page":"485","DOI":"10.1016\/j.chest.2022.02.027","volume":"162","author":"K Komici","year":"2022","unstructured":"Komici K, Bencivenga L, Navani N, D\u2019Agnano V, Guerra G, Bianco A, Rengo G, Perrotta F. Frailty in patients with Lung Cancer: a systematic review and Meta-analysis. Chest. 2022;162:485\u201397.","journal-title":"Chest"},{"key":"2981_CR16","doi-asserted-by":"publisher","first-page":"2423","DOI":"10.1007\/s11739-023-03405-6","volume":"18","author":"A Verduri","year":"2023","unstructured":"Verduri A, Carter B, Laraman J, Rice C, Clini E, Maskell NA, Hewitt J. Frailty and its influence on mortality and morbidity in COPD: a systematic review and Meta-analysis. Intern Emerg Med. 2023;18:2423\u201334.","journal-title":"Intern Emerg Med"},{"key":"2981_CR17","doi-asserted-by":"crossref","unstructured":"Barton E, Carter B, Verduri A, Hughes J, Hewitt J, Maskell NA. Long term association between frailty and survival in patients with pleural disease: a cohort study protocol. medRxiv 2023020623285492. 2023.","DOI":"10.1101\/2023.02.06.23285492"},{"key":"2981_CR18","doi-asserted-by":"publisher","first-page":"1098","DOI":"10.1136\/thoraxjnl-2014-205285","volume":"69","author":"AO Clive","year":"2014","unstructured":"Clive AO, Kahan BC, Hooper CE, Bhatnagar R, Morley AJ, Zahan-Evans N, Bintcliffe OJ, Boshuizen RC, Fysh ETH, Tobin CL, Medford ARL, Harvey JE, van den Heuvel MM, Lee YCG, Maskell NA. Predicting survival in malignant pleural effusion: development and validation of the LENT prognostic score. Thorax. 2014;69:1098\u2013104.","journal-title":"Thorax"},{"key":"2981_CR19","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1186\/s12890-015-0025-z","volume":"15","author":"MM Zamboni","year":"2015","unstructured":"Zamboni MM, da Silva CT, Baretta R, Cunha ET, Cardoso GP. Important prognostic factors for survival in patients with malignant pleural effusion. BMC Pulm Med. 2015;15:29.","journal-title":"BMC Pulm Med"},{"key":"2981_CR20","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1378\/chest.117.1.73","volume":"117","author":"CM Burrows","year":"2000","unstructured":"Burrows CM, Mathews WC, Colt HG. Predicting Survival in patients with recurrent symptomatic malignant pleural effusions. Chest. 2000;117:73\u20138.","journal-title":"Chest"},{"key":"2981_CR21","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1159\/000356764","volume":"87","author":"S Anevlavis","year":"2014","unstructured":"Anevlavis S, Kouliatsis G, Sotiriou I, Koukourakis MI, Archontogeorgis K, Karpathiou G, Giatromanolaki A, Froudarakis ME. Prognostic factors in patients presenting with Pleural Effusion revealing malignancy. Respiration. 2014;87:311\u20136.","journal-title":"Respiration"},{"key":"2981_CR22","unstructured":"National Institute of H, Clinical E. Type 2 diabetes in adults: management. 2022; 1\u201359."},{"key":"2981_CR23","doi-asserted-by":"crossref","unstructured":"Chief Operating Officer NHSSD. Chronic Obstructive Pulmonary Disease (COPD): best practice guide. 2017; 1\u201336.","DOI":"10.23880\/VIJ-16000122"},{"key":"2981_CR24","unstructured":"Public Health E. Hypertension prevalence estimates in England, 2017. 2020; 1\u201311."},{"key":"2981_CR25","unstructured":"National Centre for H, Clinical E. Chronic Heart Failure in Adults: Diagnosis and Management. London, 2018."},{"key":"2981_CR26","doi-asserted-by":"publisher","first-page":"e540","DOI":"10.1016\/S2666-7568(22)00122-2","volume":"3","author":"B Carter","year":"2022","unstructured":"Carter B, Short R, Bouamra O, Parry F, Shipway D, Thompson J, Baxter M, Lecky F, Braude P. A national study of 23 major trauma centres to investigate the effect of frailty on clinical outcomes in older people admitted with serious injury in England (FiTR 1): a multicentre observational study. Lancet Healthy Longev. 2022;3:e540\u20138.","journal-title":"Lancet Healthy Longev"},{"key":"2981_CR27","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1093\/ageing\/afy217","volume":"48","author":"J Hewitt","year":"2019","unstructured":"Hewitt J, Carter B, McCarthy K, Pearce L, Law J, Wilson FV, Tay HS, McCormack C, Stechman MJ, Moug SJ, Myint PK. Frailty predicts mortality in all emergency surgical admissions regardless of age. An observational study. Age Ageing. 2019;48:388\u201394.","journal-title":"Age Ageing"},{"key":"2981_CR28","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1097\/JTO.0b013e31817c73d6","volume":"3","author":"A Santoro","year":"2008","unstructured":"Santoro A, O\u2019Brien ME, Stahel RA, Nackaerts K, Baas P, Karthaus M, Eberhardt W, Paz-Ares L, Sundstrom S, Liu Y, Ripoche V, Blatter J, Visseren-Grul CM, Manegold C. Pemetrexed plus cisplatin or pemetrexed plus carboplatin for chemona\u00efve patients with malignant pleural mesothelioma: results of the international expanded Access Program. J Thorac Oncology: Official Publication Int Association Study Lung Cancer. 2008;3:756\u201363.","journal-title":"J Thorac Oncology: Official Publication Int Association Study Lung Cancer"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-024-02981-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-024-02981-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-024-02981-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T07:05:39Z","timestamp":1713251139000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpulmmed.biomedcentral.com\/articles\/10.1186\/s12890-024-02981-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,16]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2981"],"URL":"https:\/\/doi.org\/10.1186\/s12890-024-02981-3","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,16]]},"assertion":[{"value":"6 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"NAM has unrestricted research grants from and sits on paid advisory boards for Rocket Medical Plc and BD. The other authors have no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"for publication.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent"}},{"value":"This study was performed in accordance with the Declaration of Helsinki. This human study was approved by NRES Committee South West\u2013 Southmead - approval: 08\/H0102\/11. All adult participants provided written informed consent to participate in this study. Consent for publication not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent"}}],"article-number":"180"}}