Kinder Brent W, Brown Kevin K, McCormack Francis X, Ix Joachim H, Kervitsky Alma, Schwarz Marvin I, King Talmadge E
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Cincinnati College of Medicine; Cincinnati, OH.
Department of Medicine, National Jewish Medical and Research Center, Denver, CO.
Chest. 2009 Jun;135(6):1557-1563. doi: 10.1378/chest.08-2209. Epub 2009 Mar 2.
Serum surfactant protein (SP) A and SP-D had prognostic value for mortality in patients with idiopathic pulmonary fibrosis (IPF) in prior studies before the reclassification of the idiopathic interstitial pneumonias. We hypothesized that baseline serum SP-A and SP-D concentrations would be independently associated with mortality among patients with biopsy-proven IPF and would improve a prediction model for mortality.
We evaluated the association between serum SP-A and SP-D concentrations and mortality in 82 patients with surgical lung biopsy-proven IPF. Regression models with clinical predictors alone and clinical and biomarker predictors were used to predict mortality at 1 year.
After controlling for known clinical predictors of mortality, we found that each increase of 49 ng/mL (1 SD) in baseline SP-A level was associated with a 3.3-fold increased risk of mortality (adjusted hazard ratio, 3.27; 95% confidence interval, 1.49 to 7.17; adjusted p = 0.003) in the first year after presentation. We did not observe a statistically significant association between serum SP-D and mortality (adjusted hazard ratio, 2.04; p = 0.053). Regression models demonstrated a significant improvement in the 1-year mortality prediction model when serum SP-A and SP-D (area under the receiving operator curve [AROC], 0.89) were added to the clinical predictors alone (AROC, 0.79; p = 0.03).
Increased serum SP-A level is a strong and independent predictor of early mortality among patients with IPF. A prediction model containing SP-A and SP-D was substantially superior to a model with clinical predictors alone.
在特发性间质性肺炎重新分类之前的既往研究中，血清表面活性蛋白（SP）A和SP-D对特发性肺纤维化（IPF）患者的死亡率具有预后价值。我们假设，基线血清SP-A和SP-D浓度将与经活检证实的IPF患者的死亡率独立相关，并能改善死亡率预测模型。
我们评估了82例经外科肺活检证实为IPF的患者血清SP-A和SP-D浓度与死亡率之间的关联。使用仅包含临床预测因素以及临床和生物标志物预测因素的回归模型来预测1年时的死亡率。
在控制已知的死亡率临床预测因素后，我们发现基线SP-A水平每增加49 ng/mL（1个标准差），与出现后第一年死亡率增加3.3倍相关（调整后风险比，3.27；95%置信区间，1.49至7.17；调整后p = 0.003）。我们未观察到血清SP-D与死亡率之间存在统计学上的显著关联（调整后风险比，2.04；p = 0.053）。回归模型显示，当仅将血清SP-A和SP-D（接受者操作特征曲线下面积[AROC]，0.89）添加到临床预测因素中时（AROC，0.79；p = 0.03），1年死亡率预测模型有显著改善。
血清SP-A水平升高是IPF患者早期死亡率的一个强有力的独立预测因素。包含SP-A和SP-D的预测模型明显优于仅包含临床预测因素的模型。
