Asymmetry in acute exacerbation of idiopathic pulmonary fibrosis

Abstract

Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) results in poor survival. The objective of the present study was to elucidate the impact of asymmetrical ground-glass opacity (GGO) and/or consolidation on outcomes in patients with AE-IPF.The cases of 59 consecutive patients with AE-IPF were retrospectively reviewed. High-resolution computed tomography (HRCT) at diagnosis of an AE was assessed to determine the disease extent and asymmetry. Asymmetrical AE was defined as a right-to-left ratio of GGO and consolidation ≥2.0 or ≤0.5. The impacts of HRCT indices and other clinical parameters on 180-day mortality were analysed.The overall 180-day mortality rate was 59.2%, and asymmetrical AE was observed in 13 patients (22.0%). A multivariate analysis revealed that asymmetrical AE was a significant predictor of 180-day mortality (hazard ratio=0.36, p=0.047), long-term oxygen therapy before AE and serum lactate dehydrogenase levels. The 180-day mortality of patients with asymmetrical AE was significantly lower than that of patients with symmetrical AE (asymmetrical AE 30.8% versus symmetrical AE 68.2%, p=0.03).An asymmetrical distribution of GGO and/or consolidation is a predictor of survival in patients with AE-IPF.

Systematic review and meta-analysis of prognostic factors of acute exacerbation of idiopathic pulmonary fibrosis

“…Another result of meta-analysis demonstrated a marginal significance with an MD of −76.3 (95% CI −153.9 to 1.28; figure 4). Of the remaining two studies excluded from meta-analysis, one study reported a non-significant lower PaO 2 /FiO 2 ratio for non-survivors than survivors (195 vs 240) 56 whereas the other study demonstrated a point estimate in the opposite direction from the other studies with no statistical significance (HR 1.45 (95% CI 0.71 to 3.03) 62 ; online supplementary e-table 4). A total of five studies reported PaO 2 /FiO 2 ratio using multivariate analysis.…”

“…LDH was demonstrated to be significantly associated with all-cause mortality in four studies with HRs of 1.002 (95% CI 1.000 to 1.004), 36 1.003 (95% CI 1.001 to 1.005), 51 1.01 (95% CI 1.00 to 1.01) 42 and 1.02 (95% CI 1.00 to 1.05). 62 The other one study demonstrated non-significant result with an OR of 1.00 (95% CI 1.00 to 1.00). 47 All of these results by multivariate analysis were consistent with the combined result of univariate analysis when the result with the same summary statistics was compared although one unit of LDH to calculate HRs were unclear in some studies (online supplementary e-table 5).…”

“…A multivariate analysis reported by two studies demonstrated that oxygen therapy before AE was significantly associated with all-cause mortality of AE of IPF with HRs of 3.68 (95% CI 1.05 to 12.9) 42 and 2.34 (95% CI 1.04 to 5.28). 62 Both results by multivariate analysis were greater than the combined result of univariate analysis (online supplementary e-table 5). Figure 4 Forest plot of the result of univariate analysis for partial pressure of arterial oxygen/ fraction of inspired oxygen (PaO 2 / FiO 2 ) ratio (combined by mean difference (MD)).…”

“…The measure of hQOL was also described in one study. A total of eight research groups conducted multiple studies using the same cohort and published reports (Collard et al, 40 Kim et al, 50 Lee et al, 54 and Song et al 62 ; Kishaba et al 51 52 ; Enomoto et al [41][42][43] ; Furuya et al, 45 Isshiki et al, 46 Koyama et al, 53 and Sakamoto et al 59 ; Nikaido et al 55 and Sand et al 60 ; Kataoka et al, 48 Suzuki et al 64 and Yokoyama et al 71 ; Abe et al 35 and Atsumi et al 38 ; Tomioka et al 66 and Yamazoe et al 70 ; online supplementary e-table 1). Among these multiple research conducted by the same groups, the study with the largest sample size was prioritised and a total of 31 potential prognostic factors, which were investigated for their association with all-cause mortality, were identified and followed by further analysis (online supplementary e-table 2).…”

Idiopathic Pulmonary Fibrosis: Acute Attack

“…Çok yakın dönemde yapılan bir çalışmada, YRBT'de asimetrik tutulum olmasının mortalite için önemli bir belirteç olduğu bildirilmiştir. Ellidokuz İPF-AA hastasının dahil edildiği bu çalışmada, asimetrik tutulum olanlarda 180 günlük mortalite %30.5 iken simetrik tutulum gözlenenlerde %68.2 olarak saptanmıştır (37) . PATOLOJİ İPF-AA patolojisi; UIP paterni üzerine eklenmiş diffüz alveolar hasar veya organize pnömoninin eşlik ettiği akut akciğer hasarı ile karakterizedir (38) .…”