title: A cohort study of mortality predictors in patients with acute exacerbation of chronic fibrosing interstitial pneumonia.
abstract: OBJECTIVE
  To assess clinical, laboratory and radiographic findings associated with outcomes and to clarify more practical ways to predict hospital mortality in patients with acute exacerbation (AE) of chronic fibrosing interstitial pneumonia (CFIP).
  
  
  METHODS
  Single-centre retrospective cohort study.
  
  
  METHODS
  University Hospital in Japan.
  
  
  METHODS
  We identified 51 consecutive patients with AE of idiopathic CFIP through multidisciplinary discussion. Patients who had connective tissue disease, drug-induced lung disease, pneumoconiosis, hypersensitivity pneumonitis, sarcoidosis, pulmonary histiocytosis, lymphangioleiomyomatosis and eosinophilic pneumonia were excluded.
  
  
  METHODS
  There were no interventions.
  
  
  METHODS
  The main outcome was determination of in-hospital mortality predictors. Other outcomes included clinical, laboratory and radiographic differences between non-survivors and survivors in patients with AE of CFIP.
  
  
  RESULTS
  The mean age of the patients with AE of CFIP was 71 years. Compared with survivors, non-survivors had a significantly shorter duration of symptoms before admission, lower prevalence of peripheral distribution of ground-glass opacity and centrilobular emphysema (CLE) on thin-section CT, lower peripheral lymphocyte count, higher brain natriuretic peptide titre, lower Pao2:Fio2 (P:F) ratio, higher prevalence of systemic inflammatory response syndrome (SIRS) and higher SIRS score on admission (p=0.0069, 0.0032, 0.015, 0.040, 0.0098, 0.012, 9.9×10(-7) and 5.4×10(-6), respectively). Multivariate analysis revealed SIRS (HR=6.2810, p=0.015), CLE (HR=0.0606, p=3.6×10(-5)) and serum procalcitonin level (HR=2.7110, p=0.022) to be independent predictors of in-hospital mortality. A Kaplan-Meier estimate on the basis of stratification according to the presence or absence of SIRS and CLE demonstrated a distinct survival curve for each subset of patients.
  
  
  CONCLUSIONS
  Distinct survival curves documented by stratification according to the presence or absence of SIRS and CLE may provide basic information for a rational management strategy for patients with AE of CFIP on admission.
authors.affiliation: Department of Respiratory Medicine, Saitama Medical University, Saitama, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Usui
authors.forename: Akiko
authors.initials: A
authors.lastname: Kaga
authors.forename: Fumikazu
authors.initials: F
authors.lastname: Sakai
authors.forename: Ayako
authors.initials: A
authors.lastname: Shiono
authors.forename: Ken-Ichiro
authors.initials: K
authors.lastname: Komiyama
authors.forename: Koichi
authors.initials: K
authors.lastname: Hagiwara
authors.forename: Minoru
authors.initials: M
authors.lastname: Kanazawa
keywords: Centrilobular emphysema; Idiopathic pulmonary fibrosis; Systemic inflammatory response syndrome
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