This preprint is under consideration at Respiratory Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
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Toru Oga
Kawasaki Medical School
Corresponding Author
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Background
Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients is mainly based on registration order in Japan. However, scientific evidence for risk stratification for waitlist mortality is needed in future. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation.
Methods
Using data on 203 patients who were registered as candidates for lung transplantation from deceased donors, we analyzed factors related to waitlist mortality. Dyspnea was evaluated by the modified Medical Research Council (mMRC) dyspnea scale and health status was measured with the St. George’s Respiratory Questionnaire (SGRQ).
Results
Among 197 patients who met inclusion criteria, the main underlying disease was interstitial pneumonia (IP) in 99 patients. During the median follow-up period of 572 days, 72 patients on the waitlist died and 96 received lung transplantation (69 from deceased donor). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total were significantly associated with waitlist mortality (p = 0.003 and p < 0.001). Multivariable competing risk analyses revealed that the mMRC and SGRQ were associated with waitlist mortality, among age, IP, arterial carbon dioxide pressure, and forced vital capacity, which were all significant factors in univariable analyses.
Conclusions
Both mMRC dyspnea and SGRQ were significantly associated with waitlist mortality regardless of patients’ background, underlying disease, and pulmonary function. Patient-reported dyspnea and health should be measured not only from the perspective of multi-dimensional analysis including subjective perceptions, but also as risk stratification for waitlist mortality.
Keywords
lung transplantation, waitlist mortality, health-related quality of life, modified Medical Research Council dyspnea scale, St. George’s Respiratory Questionnaire
Figure 1
Figure 2
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1TableS1.docx
Multivariable Fine-Gray proportional hazards analysis to analyze the relationship between patient-reported outcomes and mortality in waitlisted patients excluding patients who underwent living-donor lung lobar transplantation after registration.
- Additionalfile2FigureS1.tif
Scatter plot between the LAS score and mMRC dyspnea is shown.
- Additionalfile3FigureS2.tif
Scatter plot between the LAS score and SGRQ Total is shown.
- Additionalfile4FigureS3.tif
Cumulative incidence on the waiting list comparing groups with higher and lower LAS score based on the median score.
- Additionalfile5TableS2.docx
Multivariable Fine-Gray proportional hazards analysis to analyze the relationship with mortality between the LAS and patient-reported outcomes in patients waiting for lung transplantation.
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CURRENT STATUS: Under Review
Version (no preprint)
Posted 31 Mar, 2021
Review #2 received
Received 31 Mar, 2021
Editorial decision: Minor revision
On 31 Mar, 2021
Review #1 received
Received 29 Mar, 2021
Reviewer #2 agreed
On 24 Mar, 2021
Editor assigned
On 24 Mar, 2021
Reviewers invited
Invitations sent on 24 Mar, 2021
Reviewer #1 agreed
On 24 Mar, 2021
Submission checks complete
On 24 Mar, 2021
Editor invited
On 24 Mar, 2021
This version was not preprinted
Version 1
Posted 21 Jan, 2021
No community comments so far
Review #2 received
Received 23 Feb, 2021
Editorial decision: Major revision
On 23 Feb, 2021
Reviewer #2 agreed
On 17 Feb, 2021
Review #1 received
Received 13 Feb, 2021
Reviewer #1 agreed
On 29 Jan, 2021
Reviewers invited
Invitations sent on 28 Jan, 2021
Editor assigned
On 17 Jan, 2021
Submission checks complete
On 17 Jan, 2021
Editor invited
On 17 Jan, 2021
First submitted
On 11 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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This preprint is under consideration at Respiratory Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Toru Oga
Kawasaki Medical School
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version (no preprint)
Posted 31 Mar, 2021
Review #2 received
Received 31 Mar, 2021
Editorial decision: Minor revision
On 31 Mar, 2021
Review #1 received
Received 29 Mar, 2021
Reviewer #2 agreed
On 24 Mar, 2021
Editor assigned
On 24 Mar, 2021
Reviewers invited
Invitations sent on 24 Mar, 2021
Reviewer #1 agreed
On 24 Mar, 2021
Submission checks complete
On 24 Mar, 2021
Editor invited
On 24 Mar, 2021
This version was not preprinted
Version 1
Posted 21 Jan, 2021
No community comments so far
Review #2 received
Received 23 Feb, 2021
Editorial decision: Major revision
On 23 Feb, 2021
Reviewer #2 agreed
On 17 Feb, 2021
Review #1 received
Received 13 Feb, 2021
Reviewer #1 agreed
On 29 Jan, 2021
Reviewers invited
Invitations sent on 28 Jan, 2021
Editor assigned
On 17 Jan, 2021
Submission checks complete
On 17 Jan, 2021
Editor invited
On 17 Jan, 2021
First submitted
On 11 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Waitlist mortality due to donor shortage for lung transplantation is a serious problem worldwide. Currently, the selection of recipients is mainly based on registration order in Japan. However, scientific evidence for risk stratification for waitlist mortality is needed in future. We hypothesized that patient-reported dyspnea and health would predict mortality in patients waitlisted for lung transplantation.
Methods
Using data on 203 patients who were registered as candidates for lung transplantation from deceased donors, we analyzed factors related to waitlist mortality. Dyspnea was evaluated by the modified Medical Research Council (mMRC) dyspnea scale and health status was measured with the St. George’s Respiratory Questionnaire (SGRQ).
Results
Among 197 patients who met inclusion criteria, the main underlying disease was interstitial pneumonia (IP) in 99 patients. During the median follow-up period of 572 days, 72 patients on the waitlist died and 96 received lung transplantation (69 from deceased donor). Univariable competing risk analyses revealed that both mMRC dyspnea and SGRQ Total were significantly associated with waitlist mortality (p = 0.003 and p < 0.001). Multivariable competing risk analyses revealed that the mMRC and SGRQ were associated with waitlist mortality, among age, IP, arterial carbon dioxide pressure, and forced vital capacity, which were all significant factors in univariable analyses.
Conclusions
Both mMRC dyspnea and SGRQ were significantly associated with waitlist mortality regardless of patients’ background, underlying disease, and pulmonary function. Patient-reported dyspnea and health should be measured not only from the perspective of multi-dimensional analysis including subjective perceptions, but also as risk stratification for waitlist mortality.
Figure 1
Figure 2
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