Mismatch identified in symptom burden profiles in lung transplantation.
Brittany Koons, Subhash Aryal, Nancy Blumenthal and 5 others
PMID 36841013WHAT IT FOUND
Lung transplant candidates fell into three profiles.
One in five had severe symptom burden despite average illness severity. Objective severity alone missed this group. These patients were younger, more racially diverse, and had higher psychosocial risk.
Key findings
01Among 93 lung transplant candidates, three profiles emerged: 66 had mild symptoms and mild illness severity, 8 had severe illness with moderate symptoms, and 19 had severe symptoms with average illness severity.
02One in five candidates had a more severe symptom burden than expected based on objective illness severity.
03The severe symptom burden profile was younger, more racially diverse, and had greater psychosocial vulnerability than the mild profile; it was also more often prescribed antidepressants and opioids.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was done at one transplant center, so the profiles may not match other programs. Patients with pulmonary hypertension and cystic fibrosis were underrepresented. 14% of patients were excluded because they were too sick, including those mechanically ventilated, requiring extracorporeal membrane oxygenation, or medically sedated, so results cannot be generalized to them. The sample was small and exploratory, and comparisons were not adjusted for multiple testing, so some differences may be chance. Only two and three profile models were tested; a larger sample is needed to know whether more than three profiles exist. Social factors were measured with limited data, so the study cannot show that social factors caused higher symptom burden.
Declared interests
No conflict-of-interest statement is included in the supplied text. The article is labelled as supported by non-U.S. government and N.I.H. extramural research support.
The easy way to misread this
Do not assume a higher lung allocation score means a higher symptom burden. The severe illness profile had a high lung allocation score but moderate symptoms, while the severe symptom burden profile had the highest symptoms and a relatively average lung allocation score.