title: Polymyxin-B hemoperfusion for acute exacerbation of idiopathic pulmonary fibrosis: serum IL-7 as a prognostic marker.
abstract: BACKGROUND
  Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) has an extremely poor prognosis. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) has been used to improve oxygenation for acute respiratory distress syndrome. The study aim was to retrospectively determine the predictive factors affecting the prognosis of AE of IPF treated with PMX-DHP.
  
  
  METHODS
  We studied patients suffering from AE of IPF, treated with PMX-DHP combined with high-dose corticosteroid therapy. Stored serum taken before and after PMX-DHP therapy was analyzed for 27 cytokines and chemokines.
  
  
  RESULTS
  Nineteen patients with AE of IPF were studied. The median survival time after diagnosis of AE was 22 days. Survival rates after diagnosis of AE were 47.4% at 30 days, 31.6% at 60 days, and 26.3% at 90 days. Serum levels of Interleukin (IL)-7, an anti-fibrotic cytokine, in survivors at day 30 following PMX-DHP therapy ('Survivors') significantly increased after the treatment, compared to serum levels of non-survivors at day 30 after the therapy ('Nonsurvivors'), which did not demonstrate a significant change. Serum levels of IL-1beta, interferon-y and chemokine ligand (CCL) 2 levels were not significantly altered in 'Survivors', but were significantly changed in 'Nonsurvivors.' Multivariate Cox proportional-hazards analysis showed that an increase in IL-7 levels after PMX-DHP therapy and treatment without intubation (other than invasive positive-pressure ventilation) were significantly better prognostic factors.
  
  
  CONCLUSIONS
  The results suggest that serum IL-7 may be a useful prognostic factor for patients with AE of IPF treated with PMX-DHP, possibly reflecting underlying anti-fibrotic mechanisms.
authors: Department of Diffuse Lung Diseases and Respiratory Failure, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
authors: K
authors: K
authors: Tachibana
authors: Y
authors: Y
authors: Inoue
authors: A
authors: A
authors: Nishiyama
authors: C
authors: C
authors: Sugimoto
authors: A
authors: A
authors: Matsumuro
authors: M
authors: M
authors: Hirose
authors: M
authors: M
authors: Kitaichi
authors: M
authors: M
authors: Akira
authors: T
authors: T
authors: Arai
authors: S
authors: S
authors: Hayashi
authors: Y
authors: Y
authors: Inoue
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D006464:Hemoperfusion / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D020381:Interleukin-17 / Q000097:blood*; D007564:Japan; D053208:Kaplan-Meier Estimate; D011112:Polymyxin B / Q000009:adverse effects / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D020381:Interleukin-17; D011112:Polymyxin B