The online version of this article (doi:10.1186/s12890-015-0004-4) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
Conception and design: NE. Analysis and interpretation: NE, MM, YO, MK, DH, TF, NI, YN, HS, AK, SM, MD, SS, TS. Drafting the manuscript for important intellectual content: NE, YN, TS. All authors read and approved the final manuscript.
Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis and there is currently no effective treatment for this condition. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) improves oxygenation, but it is unclear whether treatment of AE-IPF with PMX-DHP affects survival. This study elucidated the effectiveness and safety of PMX-DHP for the treatment of AE-IPF.
This study included 31 patients with 41 episodes of AE-IPF. All patients received steroids. Of 31, 14 patients (20 episodes) were treated with PMX-DHP. The laboratory and physiological test results after the start of therapy and survival were retrospectively compared between patients treated with and without PMX-DHP.
Patients treated with PMX-DHP had a significantly greater change in PaO2/FiO2 ratio (mean ± SEM, 58.2 ± 22.5 vs. 0.7 ± 13.3, p = 0.034) and a smaller change in white blood cell count (−630 ± 959 /μL vs. 4500 ± 1190 /μL, p = 0.002) after 2 days of treatment than patients treated without PMX-DHP. The 12-month survival rate was significantly higher in patients treated with PMX-DHP (48.2% vs. 5.9%, p = 0.041). PMX-DHP was effective in patients with more severe underlying disease (GAP stages II or III; 12-month survival rate 57.1% with PMX-DHP vs. 0% without PMX-DHP, p = 0.021). Treatment with PMX-DHP was an independent predictor of better prognosis (hazard ratio 0.345, p = 0.037). Mild pulmonary thromboembolism occurred in one patient treated with PMX-DHP.
Treatment of AE-IPF with PMX-DHP is tolerable and improves 12-month survival.
Additional file 1: Figure S1. Kaplan-Meier survival curves in patients who did not satisfy exclusion criteria of PMX-DHP. Six patients who satisfied exclusion criteria of PMX-DHP were excluded from the survival analysis. In 25 patients with AE-IPF, although the difference was not significant, patients treated with PMX-DHP tended to have better survival (12-month survival rate, 48.2% vs. 9.1%; log-rank test, p = 0.115).12890_2015_4_MOESM1_ESM.pptx
Additional file 2: Figure S2. Survival analysis in patients with GAP-stage II or III disease who did not satisfy exclusion criteria of PMX-DHP. In 12 patients with GAP-stage II or III disease who did not meet exclusion criteria, patients had a significant benefit from treatment with PMX-DHP (12-month survival rate, 57.1% vs. 0%; log-rank test, p = 0.048).12890_2015_4_MOESM2_ESM.pptx
Kondoh Y, Taniguchi H, Katsuta T, Kataoka K, Kimura T, Nishiyama O, et al. Risk factors of acute exacerbation of idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis. 2010;27(2):103–10. PubMed
American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. This joint statement of the American Thoracic Society (ATS), and the European Respiratory Society (ERS) was adopted by the ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir Crit Care Med. 2002;165(2):277–304. CrossRef
- Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival
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