Scientific Reports (Apr 2021)

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

  • 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

DOI
https://doi.org/10.1038/s41598-021-88718-2
Journal volume & issue
Vol. 11, no. 1
pp. 1 – 9

Abstract

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Abstract 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.