title: Impact of Comorbidities on Mortality in Patients with Idiopathic Pulmonary Fibrosis.
abstract: BACKGROUND
  Comorbidities significantly influence the clinical course of idiopathic pulmonary fibrosis (IPF). However, their prognostic impact is not fully understood. We therefore aimed to determine the impact of comorbidities, as individual and as whole, on survival in IPF.
  
  
  METHODS
  The database of a tertiary referral centre for interstitial lung diseases was reviewed for comorbidities, their treatments, their frequency and survival in IPF patients.
  
  
  RESULTS
  272 patients were identified of which 12% had no, 58% 1-3 and 30% 4-7 comorbidities, mainly cardiovascular, pulmonary and oncologic comorbidities. Median survival according to the frequency of comorbidities differed significantly with 66 months for patients without comorbidities, 48 months when 1-3 comorbidities were reported and 35 months when 4-7 comorbidities were prevalent (p = 0.004). A multivariate Cox proportional hazard analyses identified other cardiac diseases and lung cancer as significant predictors of death, gastro-oesophageal reflux disease (GERD) and diastolic dysfunction had a significant positive impact on survival. A significant impact of comorbidities associated therapies on survival was not discovered. This included the use of proton pump inhibitors at baseline, which was not associated with a survival benefit (p = 0.718). We also established a predictive tool for highly prevalent comorbidities, termed IPF comorbidome which demonstrates a new relationship of IPF and comorbidities.
  
  
  CONCLUSIONS
  Comorbidities are frequent in IPF patients. Some comorbidities, especially lung cancer, mainly influence survival in IPF, while others such as GERD may inherit a more favourable effect. Moreover, their cumulative incidence impacts survival.
authors.affiliation: Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.|Member of the German Center for Lung Research, Translational Lung Research Centre, Heidelberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kreuter
authors.affiliation: Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
authors.forename: Svenja
authors.initials: S
authors.lastname: Ehlers-Tenenbaum
authors.affiliation: Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Palmowski
authors.affiliation: ECSOR Department of Biostatistics, Gembloux, Belgium.
authors.forename: Jacques
authors.initials: J
authors.lastname: Bruhwyler
authors.affiliation: Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Oltmanns
authors.affiliation: Department of Translational Research, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.|Member of the German Center for Lung Research, Translational Lung Research Centre, Heidelberg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Muley
authors.affiliation: Diagnostic and Interventional Radiology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.|Department of Radiology, University of Heidelberg, Heidelberg, Germany.|Member of the German Center for Lung Research, Translational Lung Research Centre, Heidelberg, Germany.
authors.forename: Claus Peter
authors.initials: CP
authors.lastname: Heussel
authors.affiliation: Institute of Pathology, University of Heidelberg, Heidelberg, Germany.|Member of the German Center for Lung Research, Translational Lung Research Centre, Heidelberg, Germany.
authors.forename: Arne
authors.initials: A
authors.lastname: Warth
authors.affiliation: McMaster University, Hamilton, ON, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Kolb
authors.affiliation: Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.|Member of the German Center for Lung Research, Translational Lung Research Centre, Heidelberg, Germany.
authors.forename: Felix J F
authors.initials: FJ
authors.lastname: Herth
mesh_terms: D000368:Aged; D015897:Comorbidity; D003710:Demography; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000188:drug therapy / Q000401:mortality* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D016016:Proportional Hazards Models; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016019:Survival Analysis
chemical_list: D054328:Proton Pump Inhibitors