J Chin Med Assoc. 2022 Mar 31. doi: 10.1097/JCMA.0000000000000719. Online ahead of print.
ABSTRACT
BACKGROUND: Two antifibrotic medications, pirfenidone and nintedanib, have been approved as treatments for idiopathic pulmonary fibrosis (IPF), a life-threatening interstitial lung disease. However, there is insufficient current data regarding clinical predictors of survival for IPF patients in the era of antifibrotics.
METHODS: We retrospectively analyzed the medical records of IPF patients treated between April 2017 and May 2020. Univariate and multivariate Cox hazard proportional models were used to identify independent predictors of mortality among these patients with IPF.
RESULTS: A total of 40 IPF patients (average age: 75.58 ± 8.34 years) were included in the study, 27 (67.5%) of whom were treated with antifibrotic drugs. In the entire cohort, 14 (35%) patients died, and the overall survival of the study population was 48.52 ± 5 months (median: NA [29, NA] months). The univariate and multivariate Cox hazard proportional models indicated that chest tightness, finger clubbing, acute exacerbation after medication, decreased FVC%, and decreased FEV1% were clinical factors linked to all-cause mortality among all patients, although without statistical significance at the multivariate level. Meanwhile, only finger clubbing was a significant mortality predictor among patients who received antifibrotic medications. A mortality scoring system was built upon the aforementioned risk factors, with the exclusion of FVC%, whose individual mortality score was nearly zero.
CONCLUSION: Chest tightness, finger clubbing, acute exacerbation after medication, and decreased FVC% were clinical factors associated with mortality in IPF patients, although without statistical significance. A scoring system including these factors can be used to predict all-cause mortality in IPF patients. The mere intake of antifibrotic medications was not a significant mortality predictor in this study. This might be owed to the retrospective nature of the study, where many patients started the medications after the deterioration of their pulmonary function rather than from the start.
PMID:35353790 | DOI:10.1097/JCMA.0000000000000719
