Impact of Comorbidities on Mortality in Patients with Idiopathic Pulmonary Fibrosis

Abstract

IntroductionComorbidities significantly influence the clinical course of idiopathic pulmonary fibrosis (IPF). However, their prognostic impact is not fully understood. We therefore aimed to determine the impact of comorbidities, as individual and as whole, on survival in IPF.MethodsThe database of a tertiary referral centre for interstitial lung diseases was reviewed for comorbidities, their treatments, their frequency and survival in IPF patients.Results272 patients were identified of which 12% had no, 58% 1–3 and 30% 4–7 comorbidities, mainly cardiovascular, pulmonary and oncologic comorbidities. Median survival according to the frequency of comorbidities differed significantly with 66 months for patients without comorbidities, 48 months when 1–3 comorbidities were reported and 35 months when 4–7 comorbidities were prevalent (p = 0.004). A multivariate Cox proportional hazard analyses identified other cardiac diseases and lung cancer as significant predictors of death, gastro-oesophageal reflux disease (GERD) and diastolic dysfunction had a significant positive impact on survival. A significant impact of comorbidities associated therapies on survival was not discovered. This included the use of proton pump inhibitors at baseline, which was not associated with a survival benefit (p = 0.718). We also established a predictive tool for highly prevalent comorbidities, termed IPF comorbidome which demonstrates a new relationship of IPF and comorbidities.ConclusionComorbidities are frequent in IPF patients. Some comorbidities, especially lung cancer, mainly influence survival in IPF, while others such as GERD may inherit a more favourable effect. Moreover, their cumulative incidence impacts survival.

Body mass index—percent forced vital capacity—respiratory hospitalization: new staging for idiopathic pulmonary fibrosis patients

“…In addition, we sometimes see extra-pulmonary cause including cardiovascular disease. Therefore, we should monitor crucial comorbidity carefully in daily practice (42)(43)(44)(45).…”

Pirfenidone safety and adverse event management in idiopathic pulmonary fibrosis

“…Cardiovascular comorbidities and risk factors are common in IPF [51]. There are no specific warnings or precautions for the use of pirfenidone in patients with cardiovascular comorbidities or in those receiving concomitant anticoagulation therapy, and pharmacodynamics studies have not indicated that pirfenidone prolongs the QTc interval [8].…”

Comorbidities in interstitial lung diseases

“…Thus, in a large patient subgroup, optimal outcomes depend as much on the detection and management of major comorbid conditions as on ILD-specific therapies [1]. The number of comorbidities diagnosed in an individual patient has a significant impact on survival [2]. In this review, we describe the most common comorbidities in ILDs (table 1) with particular reference to key issues regarding diagnosis and management (tables 2 and 3).…”