A Refined Lung Transplant Frailty Scale Incorporating Serum Albumin Is Associated With Risk of Mortality in Lung Transplant Candidates
Year: 2026
Type: preprint
Abstract: The Lung Transplant Frailty Scale (LT-FS) is a validated binary measure of frailty in lung transplant candidates. We refined the LT-FS Base and Body Composition measures by developing a three-category classification to improve clinical risk stratification and replacing serum C-reactive protein with albumin as a more clinically practical frailty biomarker. We applied a 4-step measure development method to a multicenter prospective cohort study of lung transplant candidates. Low albumin (<3.5 g/dL) replaced high serum C-reactive protein (≥10 mg/L) as the LT-FS biomarker. Cutpoints balancing discrimination, risk prediction, and calibration defined “frail”, “pre-frail”, and “not frail” categories. We then evaluated these category associations with exercise capacity, patient-reported outcomes, and mortality using multivariate linear and Cox regression. Among 419 participants, the refined LT-FS identified a graded increase in mortality risk across frailty categories. Pre-frailty and frailty by LT-FS Body Composition were associated with 2.9-fold (HR 2.9, 95% CI 1.2–6.9) and 7-fold (HR 6.9, 95% CI 2.6–18.2) higher risks of waitlist delisting or death, respectively. After transplant, pre-frailty and frailty by LT-FS Body Composition were associated with 2-fold (HR 2.1, 95% CI 1.2–3.8) and 3.6-fold (HR 3.6, 95% CI 1.8–7.3) higher mortality risk, respectively. Relationships with exercise capacity and disability were less consistent. A refined Lung Transplant Frailty Scale incorporating serum albumin demonstrates strong associations with waitlist and post-transplant mortality. The addition of a pre-frail category better captures the continuum of frailty and improves clinical risk stratification of lung transplant candidates.
Source: medRxiv
Authors: Anya Sriram, Jason D Christie, Michaela R Anderson, Luke A Benvenuto, Ying Gao, Selim M Arcasoy, Daniel Calabrese, Steven R Hays, Jasleen Kukreja, Aida Venado, Legna Betancourt, Paige Gambetta, Hunter Scott, Michelle Oyster, Derek Zaleski, Joe Adler, Laurel Kalman, Shreena Patel, Michael Tevald, Kenneth E Covinsky, Chiung-Yu Huang, John R Greenland, Patricia Katz, Jonathan P Singer
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7221479600