Abstract
Background and objectives: Idiopathic pulmonary fibrosis (IPF) has a particularly poor prognosis, and most IPF-related deaths are due to acute exacerbation (AE) of this condition. Few reports about biomarkers to predict prognosis of AE-IPF have been published since the release of the new AE-IPF criteria in 2016. The present study investigated relationships between serological markers and in-hospital mortality after the onset of AE-IPF. Methods: Demographic, serological, and imaging data from patients hospitalized at the Maebashi Red Cross Hospital (Gunma, Japan) between 1 January 2013, and 31 December 2017, were retrospectively reviewed. Subjects fulfilling the diagnostic criteria for AE-IPF were divided into those who survived or died; statistical analysis of risk factors was performed using data from these two groups. Results: Diagnostic criteria for AE-IPF were fulfilled by 84 patients (59 males (70.2%)), with a median age of 78 years (range, 56–95 years). IPF was diagnosed before hospitalization in 50 (59.5%) patients and 38 (45.2%) died in hospital. Among the serological markers at hospitalization in the deceased group, C-reactive protein (CRP) was significantly higher than in the survivor group (p = 0.002), while total serum protein (p = 0.031), albumin (p = 0.047) and total cholesterol (p = 0.039) were significantly lower. Cox hazard analysis of factors predicting mortality, corrected for age, sex and BMI, revealed the following: CRP (hazard ratio (HR) 1.080 (95% confidence interval (CI) 1.022–1.141); p = 0.006), LDH (HR 1.003 (95% CI 1.000–1.006); p = 0.037), and total cholesterol (HR 0.985 (95% CI 0.972–0.997); p = 0.018). Conclusions: Our data suggest that CRP, LDH, and total cholesterol may be biomarkers predicting mortality in patients with AE-IPF. However, only prospective controlled studies can confirm or not our observation as a generalizable one.
Highlights
Among the different types of idiopathic interstitial pneumonias, idiopathic pulmonary fibrosis (IPF) has an especially poor prognosis
Risk factors reported to be associated with death due to acute exacerbation (AE)-IPF include low diffusing capacity of lungs for carbon monoxide, low forced vital capacity, smoking [4], elevated KL-6 levels, elevated high-resolution computed tomography score [5], low ratio of arterial partial pressure of oxygen
There have been numerous studies investigating the relationships between imaging and physiology tests and AE-IPF; reports describing the relationships between serological markers and AE-IPF have addressed only KL-6 and a small number of other markers
Summary
Among the different types of idiopathic interstitial pneumonias, idiopathic pulmonary fibrosis (IPF) has an especially poor prognosis. Acute exacerbation (AE) is the cause of most IPF-associated deaths: the mortality rate among patients with IPF increases to 40–80% once AE has occurred [1,2,3]. The number of published reports relating to the most recent AE-IPF diagnostic criteria, released in 2016 [8], is limited. Idiopathic pulmonary fibrosis (IPF) has a poor prognosis, and most IPF-related deaths are due to acute exacerbation (AE) of this condition. Few reports about biomarkers to predict prognosis of AE-IPF have been published since the release of the new AE-IPF criteria in 2016. Subjects fulfilling the diagnostic criteria for AE-IPF were divided into those who survived or died; statistical analysis of risk factors was performed using data from these two groups.
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