Polat Gülru, Özdemir Özer, Ermin Sinem, Serçe Unat Damla, Demirci Üçsular Fatma
Department of Pulmonology, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey.
Sarcoidosis Vasc Diffuse Lung Dis. 2024 Jun 28;41(2):e2024021. doi: 10.36141/svdld.v41i2.13779.
Any test that provides sufficient prognostic information to guide treatment decisions in idiopathic pulmonary fibrosis (IPF) is not available. The aim of our study was to determine the predictive factors of mortality in patients with IPF treated with antifibrotics.
Patients with diagnosis of IPF who were treated with antifibrotics between 2016 - 2021 were included in the study. Demographic, clinical and laboratory characteristics of the patients was derived from hospital records retrospectively. Kaplan Meier and multivariate cox regression analysis were achieved for detection of mortality predictors.
Study population was composed of 119 IPF patients with a male predominance of 80.7% (n=96). Mean age of the patients was 67.9 ± 7.07 years. On univariate analysis, sex was not a significant predictor of mortality (HR 1.79; 95% CI: 0.87 - 3.69, p =0.11). BMI ≤ 26,6 m2/kg, DLCO ≤ 3.11 ml/mmHg/min, age over 62 years, 6DWT ≤ 382 meters, NLR ≤ 2.67 and PDW ≤ 16.7% were found to be significant for predicting mortality. On multivariate cox regression analysis four parameters remained significant for prediction of mortality: RDW > 14%, NLR ≤ 2.67, BMI ≤ 26,6 m2/kg and DLCO ≤ 3.11 ml/mmHg/min (respectively, HR: 2.0. 95% CI: 1.02 - 3.91, p=0.44; HR: 2.68. 95% CI: 1.48 - 4.85, p=0.001, HR: 2.07. 95% CI: 1.14 - 3.76, p=0.02, HR: 3.46. 95% CI: 1.85 - 6.47, p<0.001). A scoring system with these parameters discriminated patients with worse prognosis with a sensitivity of 89.1 % and a specificity of 65.8 % when total point was over 2 (AUC0.83, p<0.001). Conclusions In this study, DLCO, BMI, RDW and NLR levels significantly predicted mortality in IPF patients. Along with GAP index, scoring system with these simple parameters may give information about the prognosis of an IPF patient treated with antifibrotics.
目前尚无任何一项检查能够提供足够的预后信息来指导特发性肺纤维化（IPF）的治疗决策。本研究的目的是确定接受抗纤维化治疗的IPF患者的死亡预测因素。
本研究纳入了2016年至2021年间诊断为IPF并接受抗纤维化治疗的患者。回顾性地从医院记录中获取患者的人口统计学、临床和实验室特征。采用Kaplan Meier法和多变量Cox回归分析来检测死亡预测因素。
研究人群由119例IPF患者组成，男性占80.7%（n = 96）。患者的平均年龄为67.9±7.07岁。单因素分析显示，性别不是死亡的显著预测因素（HR 1.79；95%CI：0.87 - 3.69，p = 0.11）。发现BMI≤26.6 m²/kg、DLCO≤3.11 ml/mmHg/min、年龄超过62岁、6分钟步行距离（6MWD）≤382米、中性粒细胞与淋巴细胞比值（NLR）≤2.67和血小板分布宽度（PDW）≤16.7%对预测死亡具有显著意义。多变量Cox回归分析显示，有四个参数对预测死亡仍具有显著意义：红细胞分布宽度（RDW）>14%、NLR≤2.67、BMI≤26.6 m²/kg和DLCO≤3.11 ml/mmHg/min（HR分别为：2.0，95%CI：1.02 - 3.91，p = 0.044；HR：2.68，95%CI：1.48 - 4.85，p = 0.001；HR：2.07，95%CI：1.14 - 3.76，p = 0.02；HR：3.46，95%CI：1.85 - 6.47，p<0.001）。当总分超过2分时，基于这些参数的评分系统对预后较差的患者进行鉴别，其敏感性为89.1%，特异性为65.8%（AUC 0.83，p<0.001）。结论：在本研究中，DLCO、BMI、RDW和NLR水平显著预测了IPF患者的死亡率。连同GAP指数，基于这些简单参数的评分系统可能会提供有关接受抗纤维化治疗的IPF患者预后的信息。
