Independent Clinical Factors Relevant to Prognosis of Patients with Idiopathic Pulmonary Fibrosis

Abstract

Background The prognosis of idiopathic pulmonary fibrosis (IPF) is the worst among all interstitial lung diseases, and is related to the disease itself. Comorbidities or complications can worsen IPF. We assessed the effect of comorbidities on the survival of IPF patients. A retrospective review of patients with IPF was completed. Material/Methods Information on demographic features, clinical examination, and comorbidities at baseline were obtained. Then, median, 1-year, and 5-year survival was calculated. A total of 380 patients with IPF admitted to Beijing Chao-Yang Hospital from 1 April 2002 to 31 March 2015 were followed up until December 2016. Results Of these 380 patients, 71.9% died during the study period. Median survival was 2.25 years and overall 5-year survival was 28.5%. Also, 86.3% of patients were males. A total of 248 cases underwent lung function tests, and 178 patients underwent bronchoalveolar lavage (BAL). Multivariate analyses showed that forced expiratory volume in 1 second/forced vital capacity (FVC), diffusing capacity of the lungs for carbon monoxide percent predicted, FVC% predicted, the number of macrophages, neutrophils, and lymphocytes in BAL fluid, pulmonary hypertension, hypoxemia, and hydropower disorder were independent prognostic indicators of IPF, GAP gender (G), age (A), and 2 pulmonary physiological parameters (P) model can help to predict prognosis of IPF. Conclusions Spirometry, GAP model, and BAL are helpful to forecast the prognosis of IPF. IPF patients also suffering from pulmonary arterial hypertension, hypoxemia, and hydropower disorder have a poor prognosis.

Antithrombin III as predictive indicator of survival in idiopathic pulmonary fibrosis (IPF) patients treated with nintedanib: a preliminary study

“…A link between ATIII and neutrophil activity can be supposed irrespective of coagulation cascade regulation, because ATIII interacts with cell mediators of inflammation, which are mainly produced by neutrophils 22,23 . Polymorphonuclear cells are involved in fibrotic mechanisms in the lung and increased percentages of neutrophils have been demonstrated in BAL and tissues of IPF patients 24,25 . Interestingly, we found significant correlations between ATIII concentrations and pulmonary function test parameters, which strongly suggest the potential prognostic value of ATIII in the pathogenesis of IPF.…”

“…22,23 Polymorphonuclear cells are involved in fibrotic mechanisms in the lung and increased percentages of neutrophils have been demonstrated in BAL and tissues of IPF patients. 24,25 Interestingly, we found significant correlations between ATIII concentrations and pulmonary function test parameters, which strongly suggest the potential prognostic value of ATIII in the pathogenesis of IPF. ATIII levels in serum were also directly correlated with BAL neutrophil percentages and both parameters seem reliable predictors of poor survival.…”

The Gender–Age–Physiology System as a Prognostic Model in Patients with Idiopathic Pulmonary Fibrosis Treated with Nintedanib: A Longitudinal Cohort Study

“…In the present study, elderly people (> 65 years) did not have a worse prognosis than young people (≤ 60 years). While Song et al [29] reported that younger patients (< 50 years) tended to have a good prognosis compared to that of elderly patients (> 75 years), the difference was not significant (Kolmogorov-Smirnov test, p = 0.268). One potential reason for this difference is due to nintedanib's high frequency of side effects (e.g., diarrhea, anorexia, liver injury) [10].…”

“…In the original report of the GAP system by Ley et al [19], sex had a lower impact on prognosis compared with other factors. Although mortality due to IPF was initially reported to be higher in men [12], a recent study by Song et al [29] found that among 380 patients with IPF, survival time was nearly equivalent between male (46.6 months) and female (45.0 months) patients (Chi-squared test, p = 0.887). These findings are consistent with the outcome of our study and together suggest that the administration of nintedanib does not affect the relationship between gender and prognosis.…”

The prognostic role of gender, age and physiology index and C-reactive protein/albumin ratio in idiopathic pulmonary fibrosis

“…The presence of comorbidities with IPF can significantly influence the prognosis. Song et al (24) and Cai et al (27) showed in their studies that PAH was associated with a poor outcome. Distance walked in 6 min was independently related to mortality by multivariate analysis in Caminati and coworkers' study (28).…”