Satsuma Lab, Centre for Medical Image Computing, UCL, London, UK.
UCL Respiratory, UCL, London, UK.
Respir Res. 2024 Jun 19;25(1):249. doi: 10.1186/s12931-024-02875-2.
Our study examined whether prevalent and incident comorbidities are increased in idiopathic pulmonary fibrosis (IPF) patients when compared to matched chronic obstructive pulmonary disease (COPD) patients and control subjects without IPF or COPD.
IPF and age, gender and smoking matched COPD patients, diagnosed between 01/01/1997 and 01/01/2019 were identified from the Clinical Practice Research Datalink GOLD database multiple registrations cohort at the first date an ICD-10 or read code mentioned IPF/COPD. A control cohort comprised age, gender and pack-year smoking matched subjects without IPF or COPD. Prevalent (prior to IPF/COPD diagnosis) and incident (after IPF/COPD diagnosis) comorbidities were examined. Group differences were estimated using a t-test. Mortality relationships were examined using multivariable Cox proportional hazards adjusted for patient age, gender and smoking status.
Across 3055 IPF patients, 38% had 3 or more prevalent comorbidities versus 32% of COPD patients and 21% of matched control subjects. Survival time reduced as the number of comorbidities in an individual increased (p < 0.0001). In IPF, prevalent heart failure (Hazard ratio [HR] = 1.62, 95% Confidence Interval [CI]: 1.43-1.84, p < 0.001), chronic kidney disease (HR = 1.27, 95%CI: 1.10-1.47, p = 0.001), cerebrovascular disease (HR = 1.18, 95%CI: 1.02-1.35, p = 0.02), abdominal and peripheral vascular disease (HR = 1.29, 95%CI: 1.09-1.50, p = 0.003) independently associated with reduced survival. Key comorbidities showed increased incidence in IPF (versus COPD) 7-10 years prior to IPF diagnosis.
The mortality impact of excessive prevalent comorbidities in IPF versus COPD and smoking matched controls suggests that multiorgan mechanisms of injury need elucidation in patients that develop IPF.
本研究旨在比较特发性肺纤维化（IPF）患者与匹配的慢性阻塞性肺疾病（COPD）患者和无 IPF 或 COPD 的对照组患者，以评估其是否存在更多的常见合并症。
我们从临床实践研究数据链接 GOLD 数据库的多个注册队列中，确定了 1997 年 1 月 1 日至 2019 年 1 月 1 日期间首次出现 ICD-10 或阅读代码提及 IPF/COPD 的 IPF 和年龄、性别和吸烟匹配的 COPD 患者。对照组由年龄、性别和吸烟包年匹配的无 IPF 或 COPD 的患者组成。研究了常见（在 IPF/COPD 诊断之前）和新发（在 IPF/COPD 诊断之后）合并症。使用 t 检验估计组间差异。使用多变量 Cox 比例风险模型调整患者年龄、性别和吸烟状况后，评估死亡率关系。
在 3055 例 IPF 患者中，38%有 3 种或更多常见合并症，而 COPD 患者为 32%，匹配对照组为 21%。随着个体合并症数量的增加，生存时间缩短（p<0.0001）。在 IPF 中，常见的心力衰竭（HR=1.62，95%置信区间[CI]：1.43-1.84，p<0.001）、慢性肾脏病（HR=1.27，95%CI：1.10-1.47，p=0.001）、脑血管病（HR=1.18，95%CI：1.02-1.35，p=0.02）和腹部及外周血管疾病（HR=1.29，95%CI：1.09-1.50，p=0.003）与生存率降低独立相关。关键合并症在 IPF 诊断前 7-10 年的发生率在 IPF 中高于 COPD。
与 COPD 和吸烟匹配的对照组相比，IPF 中过多常见合并症的死亡率影响表明，需要阐明发生 IPF 的患者多器官损伤的机制。
