Background
Methods
Data source
Patient selection and data retrieval
Definition of variables
Statistical analyses
Results
Patient characteristics
N (%) | Mean ± SD | |
---|---|---|
Patients | 209 | |
Age, years | 209 | 72.3 ± 9.6 |
<60 | 17 (8.1) | |
60–69 | 52 (24.9) | |
70–79 | 98 (46.9) | |
≥80 | 42 (20.1) | |
Male | 172 (82.3) | |
BMI, kg/m2
| 178 | 22.3 ± 3.8 |
<18.5 | 27 (15.2) | |
18.5–25 | 114 (64.0) | |
>25 | 37 (20.8) | |
Brinkman Index | 184 | 599.5 ± 675.7 |
0 | 68 (37.0) | |
1–800 | 45 (24.5) | |
>800 | 71 (33.6) | |
F, H-J Classification scale | 166 | |
1 | 2 (1.2) | |
2 | 4 (2.4) | |
3 | 7 (4.2) | |
4 | 28 (16.9) | |
5 | 125 (75.3) | |
Season | ||
Spring | 48 (23.0) | |
Summer | 34 (16.2) | |
Fall | 56 (26.8) | |
Winter | 71 (34.0)* | |
Specialty hospital | ||
Yes/No | 173 (82.8)/36 (17.2) | |
Arrival by ambulance | ||
Yes/No | 101 (48.3)/108 (51.7) |
Outcome
Survivors | Non-survivors |
p-value | |
---|---|---|---|
Patients | 71 | 138 | |
Age, years | 69.3 ± 10.2 | 73.8 ± 8.8 | 0.002 |
Male | 56 (78.9) | 116 (84.1) | 0.352 |
BMI, kg/m2
| 22.2 ± 3.9 | 22.3 ± 3.8 | 0.795 |
Brinkman Index | |||
0/1–800/>800 | 26/14/25 | 42/31/46 | 0.719 |
F, H-J Classification scale | |||
1/2/3/4/5 | 1/3/3/16/42 | 1/1/4/12/83 | 0.012 |
Specialty hospital care | 60 (84.5) | 113 (81.9) | 0.634 |
Ambulance transfer | 32 (45.1) | 69 (50.0) | 0.499 |
Performing bronchoscopy | 14 (19.7) | 6 (4.4) | <0.001 |
Treatment regimen use | |||
Sivelestat | 37 (52.1) | 67 (48.9) | 0.626 |
Diuretic drug | 37 (52.1) | 65 (47.1) | 0.492 |
Anticoagulant therapy | 37 (52.1) | 50 (36.2) | 0.027 |
Immunosuppressive therapy | 30 (42.3) | 45 (32.6) | 0.169 |
Intravenous high-dose cyclophosphamide | 9 (12.7) | 23 (16.7) | 0.448 |
PMX | 4 (5.6) | 9 (6.5) | 0.801 |
Recombinant human soluble thrombomodulin | 3 (4.2) | 6 (4.4) | 0.967 |
Antibiotic therapy | 71 (100) | 135 (97.8) | 0.211 |
β-Lactams | 60 (84.5) | 116 (84.1) | 0.933 |
Co-trimoxazole | 56 (78.9) | 59 (42.8) | <0.001 |
Quinolones | 38 (53.5) | 65 (47.1) | 0.379 |
Macrolides | 23 (32.4) | 25 (18.1) | 0.020 |
Tetracycline | 6 (8.5) | 12 (8.7) | 0.952 |
Anti-MRSA antibiotics | 6 (8.5) | 11 (7.8) | 0.904 |
Clindamycin | 3 (4.2) | 2 (1.5) | 0.214 |
Aminoglycoside | 2 (2.8) | 1 (0.7) | 0.228 |
Others | 5 (7.0) | 7 (5.1) | 0.562 |
Prognostic factors
Variable | Univariate logistic analysis | Multivariate logistic analysis | |||||
---|---|---|---|---|---|---|---|
N (%) | OR | 95 % Cl |
p-value | OR | 95 % Cl |
p-value | |
Age, years | 209 | ||||||
<60 | 17 (8.1) | ref | ref | ||||
60–69 | 52 (24.9) | 1.12 | 0.374–3.362 | 0.839 | |||
70–79 | 98 (46.9) | 1.83 | 0.647–5.196 | 0.254 | |||
≥80 | 42 (20.1) | 3.78 | 1.110–12.858 | 0.033 | 2.94 | 1.044–8.303 | 0.041 |
Male | 172 (82.3) | 1.41 | 0.681–2.930 | 0.354 | |||
BMI, kg/m2
| 178 | ||||||
<18.5 | 27 (15.2) | ref | |||||
18.5–25 | 114 (64.0) | 1.43 | 0.604–3.388 | 0.415 | |||
>25 | 37 (20.8) | 1.13 | 0.409–3.117 | 0.814 | |||
Brinkman Index | 184 | ||||||
0 | 68 (37.0) | ref | |||||
1–800 | 45 (24.5) | 1.37 | 0.617–3.046 | 0.439 | |||
>800 | 71 (33.6) | 1.14 | 0.571–2.271 | 0.712 | |||
F, H-J Classification scale | 166 | ||||||
1–4 | 41 (24.7) | ref | ref | ||||
5 | 125 (75.3) | 2.53 | 1.229–5.187 | 0.012 | 2.13 | 0.931–4.856 | 0.073 |
Specialty hospital care | 173 (82.8) | 0.83 | 0.382–1.799 | 0.635 | |||
Ambulance transfer | 101 (48.3) | 1.22 | 0.686–2.164 | ||||
Performing bronchoscopy | 20 (9.6) | 0.19 | 0.068–0.506 | 0.001 | 0.25 | 0.079–0.798 | 0.019 |
Sivelestat | 104 (49.8) | 0.87 | 0.489–1.538 | 0.626 | |||
Diuretic drug | 102 (48.8) | 0.82 | 0.461–1.451 | 0.493 | |||
Anticoagulant therapy | 87 (41.6) | 0.52 | 0.292–0.933 | 0.028 | |||
Immunosuppressive therapy | 75 (35.9) | 0.66 | 0.366–1.193 | 0.17 | |||
Intravenous high-dose cyclophosphamide | 32 (15.3) | 1.38 | 0.601–3.160 | 0.449 | 3.17 | 1.101–9.148 | 0.033 |
PMX | 13 (6.2) | 1.17 | 0.347–3.935 | 0.801 | |||
Recombinant human soluble thrombomodulin | 9 (4.3) | 1.03 | 0.250–4.247 | 0.967 | |||
Antibiotic therapy | 206 (98.6) | – | – | ||||
β-Lactams | 176 (84.2) | 0.97 | 0.440–2.126 | 0.933 | |||
Co-trimoxazole | 115 (55.0) | 0.20 | 0.103–0.388 | <0.001 | 0.28 | 0.132–0.607 | |
Quinolones | 103 (49.3) | 0.77 | 0.436–1.372 | 0.38 | |||
Macrolides | 48 (23.0) | 0.46 | 0.239–0.893 | 0.022 | 0.37 | 0.155–0.867 | |
Tetracycline | 18 (8.6) | 1.03 | 0.370–2.875 | 0.952 | |||
Anti-MRSA antibiotics | 17 (8.1) | 0.94 | 0.332–2.651 | 0.904 | |||
Clindamycin | 5 (2.4) | 0.33 | 0.054–2.042 | 0.235 | |||
Aminoglycoside | 3 (1.4) | 0.25 | 0.022–2.826 | 0.264 | |||
Others | 12 (5.7) | 0.71 | 0.216–2.307 | 0.564 |
The relationship between survival and co-trimoxazole dosage
Discussion
Conclusion
Key messages
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Rapid progression of respiratory failure in IPF patients was frequently seen in the winter. Older age and a higher grade of dyspnea on admission were poor prognostic factors. In addition, the prognosis of the patients did not differ in relation to the geographic area of Japan or in patients who were treated in a specialized hospital.
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The results of this study indicate that the prognosis of patients who underwent a bronchoscopic examination was better prognosis than those who did not; however, the performance of bronchoscopy in AE-IPF patients might be controversial.
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Regarding the treatment of IPF patients with rapid progression of respiratory failure, the use of high-dose corticosteroids in combination with macrolides and co-trimoxazole may lead to a better prognosis. However, prospective randomized controlled trials are necessary to elucidate the clinical effects of these agents.