Risk factors for an acute exacerbation of idiopathic pulmonary fibrosis

Kakugawa, Tomoyuki; Sakamoto, Noriho; Sato, Shuntaro; Yura, Hirokazu; Harada, Tatsuhiko; Nakashima, Shota; Hara, Atsuko; Oda, Kazuhiro; Ishimoto, Hiroshi; Yatera, Kazuhiro; Ishimatsu, Yuji; Obase, Yasushi; Kohno, Shigeru; Mukae, Hiroshi

doi:10.1186/s12931-016-0400-1

Cited by 60 publications

(65 citation statements)

References 36 publications

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“…Preceding studies on acute exacerbation mainly focused on AE-IPF. And the annual incidence of AE-IPF ranged from 7 to 19.1% in different clinical trials and retrospective studies (20)(21)(22)(23)(24)(25). Knowledge on AE-ILD in non-IPF patients, namely connective-tissue-disease-related ILD (CTD-ILD), was limited.…”

Section: Discussionmentioning

confidence: 99%

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Liang

Sun

et al. 2020

Front. Med.

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This study aimed at clarifying the prevalence, risk factors, outcome, and outcome-related factors of acute exacerbation of interstitial lung disease (AE-ILD) in patients with idiopathic inflammatory myopathy (IIM). Methods: Data of IIM patients who were admitted to the First Affiliated Hospital of Zhejiang University (FAHZJU) from September 2007 to September 2019 were retrospectively collected. And the IIM patients with AE-ILD formed the case group. In addition, age and sex matched IIM patients without AE-ILD were randomly selected to constitute the control group. A 1:2 case-control study and intragroup analysis were performed to identify risk factors for development of AE-ILD in IIM patients and unfavorable short-term outcome in AE-ILD patients through comparison, univariate and multivariate logistic regression analysis. Results: AE-ILD occurred in 64 out of 665 IIM patients (9.6%) with a short-term mortality rate of 39.1%. And the 64 IIM patients with AE-ILD formed the case group. Besides, 128 age and sex matched IIM patients without AE-ILD were randomly selected to constitute the control group. The retrospective case-control study revealed that elevated on-admission disease activity (P < 0.001), lower percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.013) and diagnosis of clinically amyopathic dermatomyositis (CADM, P = 0.007) were risk factors for development of AE-ILD in IIM patients. The following intragroup analysis indicated that elevated on-admission disease activity (P = 0.008) and bacterial infection (P = 0.003) were significantly correlated with the unfavorable short-term outcome of patients complicated with AE-ILD. In addition, combined use of steroid and disease modifying antirheumatic drugs (DMARDs, P = 0.006) was found to significantly reduce the short-term mortality in IIM patients with AE-ILD. Conclusion: AE-ILD is a less frequent but fatal complication in IIM patients with elevated on-admission disease activity, lower DLCO% and diagnosis of CADM working as risk factors, indicating the potential roles of autoimmune abnormality and hypoxia in development of AE-ILD. Elevated on-admission disease activity and bacterial infection could predict unfavorable short-term outcome of IIM patients with AE-ILD. A therapeutic regimen of steroid and DMARDs was found to reduce short-term death in these patients.

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Section: Discussionmentioning

confidence: 99%

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Liang

Sun

et al. 2020

Front. Med.

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“…10 However, other studies have reported that KL-6 cannot reliably predict increased risk for AE. 11,12 Therefore, there is a need to identify biomarkers that can easily and reliably predict an increased risk for AE.…”

Section: Introductionmentioning

confidence: 99%

Monocyte count and the risk for acute exacerbation of fibrosing interstitial lung disease: A retrospective cohort study

et al. 2020

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Recent studies have suggested that an increased peripheral monocyte count predicts a poor outcome in fibrosing interstitial lung disease (ILD). However, the association between an increased monocyte count and acute exacerbations (AEs) of fibrosing ILD remains to be elucidated. Our retrospective cohort study aimed to assess the impact of peripheral monocyte count on AEs of fibrosing ILD. We analyzed the electronic medical records of 122 consecutive patients with fibrosing ILD and no prior history of an AE, who were treated with anti-fibrotic agents from August 2015 to December 2018. We determined their peripheral monocyte counts at anti-fibrotic agent initiation and performed univariate and multivariate Cox regression analyses of time-to-first AE after anti-fibrotic agent initiation to assess the impact of monocyte count on AEs of fibrosing ILD. Twenty-six patients developed an AE during the follow-up period, and there was an increased monocyte count at anti-fibrotic agent initiation in these patients compared to those who did not develop an AE. There was also a significantly shorter time-to-first AE of fibrosing ILD in patients with a higher absolute monocyte count. Subgroup analyses indicated similar results regardless of the idiopathic pulmonary fibrosis diagnoses. This association was independently significant after adjusting for the severity of the fibrosing ILD. Using our results, we developed a simple scoring system consisting of two factors—monocyte count (<>380 µL−1) and ILD-gender, age, physiology score (<>4 points). Our findings suggest that the absolute monocyte count is an independent significant risk factor for AE in patients with fibrosing ILD. Our simple scoring system may be a predictor for AEs of fibrosing ILD, although further studies are needed to verify our findings.

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“…1). Entsprechend der neuen Definition wird eine akute Exazerbation wie folgt definiert: 1. bekannte oder zeitgleich mit der Exazerbation gestellte IPF-Diagnose, [15].…”

Section: Akute Exazerbation Der Idiopathischen Pulmonalen Fibroseunclassified

“…Serumbiomarker wie LDH (Laktatdehydrogenase), Surfactantprotein-D und erhöhte KL-6-Serumspiegel haben einen potenziellen klinischen Nutzen zur Identifizierung von Risikopatienten gezeigt [15,18].…”

Section: Identifizierung Der Risikopatientenunclassified

“…Der Eosinophilen-und Neutrophilengehalt in der BAL wurde auch mit dem Risiko für eine akute Exazerbation assoziiert [15]. Es liegen auch Daten über eine mögliche Assoziation zwischen Genpolymorphismen, im Speziellen innerhalb der Mucine (MUC) und Telomerasenkodierenden Gene (TERT) [19], Gensignaturen [20] und AE-IPF vor, die noch durch Validierungsstudien bestätigt werden müssen.…”

Section: Identifizierung Der Risikopatientenunclassified

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Therapie von Komplikationen und nichtpharmakologisches Management der idiopathischen pulmonalen Fibrose

2020

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Risk factors for an acute exacerbation of idiopathic pulmonary fibrosis

Cited by 60 publications

References 36 publications

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Acute Exacerbation of Interstitial Lung Disease in Adult Patients With Idiopathic Inflammatory Myopathies: A Retrospective Case-Control Study

Monocyte count and the risk for acute exacerbation of fibrosing interstitial lung disease: A retrospective cohort study

Therapie von Komplikationen und nichtpharmakologisches Management der idiopathischen pulmonalen Fibrose

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