Viral Infection Increases the Risk of Idiopathic Pulmonary Fibrosis

Abstract

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic lung disease with a poor prognosis. Although many factors have been identified that possibly trigger or aggravate IPF, such as viral infection, the exact cause of IPF remains unclear. Until now, there has been no systematic review to assess the role of viral infection in IPF quantitatively.OBJECTIVE: This meta-analysis aims to present a collective view on the relationship between viral infection and IPF. METHODS:We searched studies reporting the effect of viral infection on IPF in the PubMed, Embase, Cochrane Library, Web of Science, and Wiley Online Library databases. We calculated ORs with 95% CIs to assess the risk of virus in IPF. We also estimated statistical heterogeneity by using I 2 and Cochran Q tests and publication bias by using the funnel plot, Begg test, Egger test, and trim-and-fill methods. Regression, sensitivity, and subgroup analyses were performed to assess the effects of confounding factors, such as sex and age. RESULTS:We analyzed 20 case-control studies from 10 countries with 1,287 participants. The pooled OR of all viruses indicated that viral infection could increase the risk of IPF significantly (OR, 3.48; 95% CI, 1.61-7.52; P ¼ .001), but not that of exacerbation of IPF (OR, 0.99; 95% CI, 0.47-2.12; P ¼ .988). All analyzed viruses, including Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 7 (HHV-7), and human herpesvirus 8 (HHV-8), were associated with a significant elevation in the risk of IPF, except human herpesvirus 6 (HHV-6). CONCLUSIONS:The presence of persistent or chronic, but not acute, viral infections, including EBV, CMV, HHV-7, and HHV-8, significantly increases the risk of developing IPF, but not exacerbation of IPF. These findings imply that viral infection could be a potential risk factor for IPF.

Clinical characteristics of hospitalized patients with SARS‐CoV‐2 infection: A single arm meta‐analysis

“…Since the case fatality rate of patients with SARS‐CoV‐2 infection is low, a large number of patients with SARS‐CoV‐2 infection will be cured. Sheng et al 22 have shown that viral infection could increase the risk of pulmonary fibrosis. Xie et al 23 found that 45% of patients showed signs of pulmonary fibrosis within 1 month after being infected with SARS‐CoV.…”

Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study

“…Despite the unknown risk of COVID-19 for patients with ILD, many patients chose to self-isolate and, therefore, there appeared to be apparent 'protection' from observed to many ILD physicians around the world. The role of viral infection promoting acute exacerbations of ILD has been investigated for a number of years without a definitive answer, which probably reflects the range of viruses studied, the number of patients needed to explore such a hypothesis, and more broadly the challenges studying acute exacerbations of ILD (14,15,16,17). These data confirm that patients with ILD are at increased risk of mortality from COVID-19 compared with a matched population without ILD and the risk is greatest for IPF consistent with a respiratory virus inducing acute exacerbations of ILD.…”

Clinical characteristics of 50466 patients with 2019-nCoV infection

“…Gaohong Sheng et al [22] have shown that viral infection could increase the risk of pulmonary fibrosis. Xie et al [23] found that 45% of patients showed signs of pulmonary fibrosis within one month after being infected with SARS-CoV.…”