Prognostic classification in acute exacerbation of idiopathic pulmonary fibrosis: a multicentre retrospective cohort study

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作者
Takahito Suzuki
Hironao Hozumi
Koichi Miyashita
Masato Kono
Yuzo Suzuki
Masato Karayama
Kazuki Furuhashi
Hirotsugu Hasegawa
Tomoyuki Fujisawa
Noriyuki Enomoto
Yutaro Nakamura
Naoki Inui
Koshi Yokomura
Hidenori Nakamura
Takafumi Suda
机构
[1] Hamamatsu University School of Medicine,Second Division, Department of Internal Medicine
[2] Seirei Hamamatsu General Hospital,Department of Respiratory Medicine
[3] Seirei Mikatahara General Hospital,Department of Respiratory Medicine
[4] Hamamatsu University School of Medicine,Department of Clinical Pharmacology and Therapeutics
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Scientific Reports | / 11卷
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摘要
Acute exacerbation (AE) in idiopathic pulmonary fibrosis (IPF) is a major prognostic determinant. However, evidence for its prognostic strength is mainly based on the results of small cohort studies with statistical limitations. This retrospective study, which included 108 patients with a first episode of AE-IPF, aimed to identify prognostic factors and to develop prognostic classification models. Multivariate Cox regression analysis revealed that a lower percent-predicted forced vital capacity within 12 months before AE onset (baseline %FVC) and a lower PaO2/FiO2 ratio at AE onset were independent mortality predictors. If the value of each predictor was lower than the cutoff determined by receiver-operating characteristic analysis, 1 point was assigned. Classification of patients into mild, moderate, and severe groups based on total score showed post-AE 90-day cumulative survival rates of 83.3%, 66.2%, and 22.2%, respectively (model 1: C-index 0.702). Moreover, a decision tree-based model was created with the recursive partitioning method using baseline %FVC and PaO2/FiO2 ratio at AE onset from among multivariable; accordingly, patients were classified into 3 groups with post-AE 90-day cumulative survival rates of 84.1%, 64.3%, and 24.0%, respectively (model 2: C-index 0.735). These models can guide clinicians in determining therapeutic strategies and help design future studies on AE-IPF.
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