title: Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival.
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.
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. norieno@hama-med.ac.jp.
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Enomoto
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. mas.mik@hama-med.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mikamo
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. bigmountaing@yahoo.co.jp.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Oyama
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. konomasato28@yahoo.co.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Kono
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. dai@hama-med.ac.jp.
authors.forename: Dai
authors.initials: D
authors.lastname: Hashimoto
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. fujisawa@hama-med.ac.jp.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujisawa
authors.affiliation: Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan. inui@hama-med.ac.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Inui
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. nakayuta@hama-med.ac.jp.
authors.forename: Yutaro
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Internal Medicine 1, Hamamatsu University School of Medicine, Hamamatsu, Japan. ysdh@hama-med.ac.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasuda
authors.affiliation: Blood Purification Unit, Hamamatsu University Hospital, Hamamatsu, Japan. a.kato@hama-med.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Kato
authors.affiliation: Intensive Care Unit, Hamamatsu University Hospital, Hamamatsu, Japan. mimsou@hotmail.com.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Mimuro
authors.affiliation: Intensive Care Unit, Hamamatsu University Hospital, Hamamatsu, Japan. matdoi@hama-med.ac.jp.
authors.forename: Matsuyuki
authors.initials: M
authors.lastname: Doi
authors.affiliation: Department of Anesthesia and Resuscitation, University Hospital, Hamamatsu University School of Medicine, Hamamatsu, Japan. shige-15@hama-med.ac.jp.
authors.forename: Shigehito
authors.initials: S
authors.lastname: Sato
authors.affiliation: Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan. suda@hama-med.ac.jp.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Suda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000276:immunology / Q000628:therapy*; D055767:Immobilized Proteins / Q000627:therapeutic use*; D007958:Leukocyte Count; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D055767:Immobilized Proteins; D011112:Polymyxin B