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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Pulmonary Medicine 1/2015

Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival

Zeitschrift:
BMC Pulmonary Medicine > Ausgabe 1/2015
Autoren:
Noriyuki Enomoto, Masashi Mikamo, Yoshiyuki Oyama, Masato Kono, Dai Hashimoto, Tomoyuki Fujisawa, Naoki Inui, Yutaro Nakamura, Hideo Yasuda, Akihiko Kato, Soichiro Mimuro, Matsuyuki Doi, Shigehito Sato, Takafumi Suda
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12890-015-0004-4) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

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.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

Treatment of AE-IPF with PMX-DHP is tolerable and improves 12-month survival.
Zusatzmaterial
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
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