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Demographic factors associated with within-individual variability of lung function for adults with cystic fibrosis: A UK registry study.

Accepted version
Peer-reviewed

Type

Article

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Authors

Keogh, Ruth H 
Carr, Siobhán B 
Szczesniak, Rhonda 
Taylor-Robinson, David 

Abstract

BACKGROUND: Lung function is a key outcome used in the evaluation of disease progression in cystic fibrosis. The variability of individual lung function measurements over time (within-individual variability) has been shown to predict subsequent lung function changes. Nevertheless, the association between within-individual lung function variability and demographic and genetic covariates has not been quantified. METHODS: We performed a longitudinal analysis of data from a cohort of 7099 adults with cystic fibrosis (between 18 and 49 years old) from the UK cystic fibrosis registry, containing annual review data between 1996 and 2020. A mixed-effects location-scale model is used to quantify mean FEV1 (forced expiratory volume in 1 s) trajectories and FEV1 within-individual variability as a function of sex, age at annual review, diagnosis after first year of life, homozygous F508 genotype and birth cohort. RESULTS: Mean FEV1 decreased with age and lung function variability showed a near-quadratic trend by age. Males showed higher FEV1 mean and variability than females across the whole age range. Earlier diagnosis and homozygous F508 genotype were also associated with higher FEV1 mean and variability. Individuals who died during follow-up showed on average higher lung function variability than those who survived. CONCLUSIONS: Key variables known to be linked with mean lung function in cystic fibrosis are also associated with an individual's lung function variability. This work opens new avenues to understand the role played by lung function variability in disease progression and its utility in predicting key outcomes such as mortality.

Description

Keywords

Cystic fibrosis, Lung function variability, Mixed-effects location-scale model (MELSM), Within-individual variability

Journal Title

J Cyst Fibros

Conference Name

Journal ISSN

1569-1993
1873-5010

Volume Title

Publisher

Elsevier BV
Sponsorship
MRC (MR/V020595/1)
National Institute for Health Research (NIHR) (via Cambridge University Hospitals NHS Foundation Trust (CUH)) (Unknown)
MP was supported by the MRC grant “Looking beyond the mean: what within-person variability can tell us about dementia, cardiovascular disease and cystic fibrosis” (MR/V020595/1). JKB was supported by MRC Unit Programme MC_UU_00002/5. RHK was funded by UK Research and Innovation (Future Leaders Fellowship MR/S017968/1). RS was supported by the National Heart, Lung and Blood Institute of the National Institutes of Health (R01 HL141286) and Cystic Fibrosis Foundation (Naren19R0 and SZCZES22AB0). GM-T acknowledges the support of the Osteopathic Heritage Foundation through funding for the Osteopathic Heritage Foundation Ralph S. Licklider, D.O., Research Endowment in the Heritage College of Osteopathic Medicine