title: Clinical Impact of Emphysema Evaluated by High-Resolution Computed Tomography on Idiopathic Pulmonary Fibrosis Diagnosed by Surgical Lung Biopsy.
abstract: BACKGROUND
  The prognosis of combined cases of pulmonary fibrosis and emphysema is unresolved partially because radiological differentiation between usual interstitial pneumonia and nonspecific interstitial pneumonia is difficult in coexisting emphysema cases.
  
  
  OBJECTIVE
  The purpose of this study was to clarify the clinical impact of emphysema on the survival of patients with idiopathic pulmonary fibrosis (IPF).
  
  
  METHODS
  One hundred and seven patients with interstitial lung diseases were diagnosed by surgical lung biopsies between 2006 and 2012, and 47 patients were diagnosed with IPF through multidisciplinary discussion. Emphysema on high-resolution computed tomography scans was evaluated semiquantitatively by visual scoring.
  
  
  RESULTS
  Eight out of the 47 IPF patients showed a higher emphysema score (>3) and were diagnosed to have IPF-emphysema. The median survival time of patients with IPF-emphysema (1,734 days) from the initial diagnosis was significantly shorter than that of patients with IPF alone (2,229 days) by Kaplan-Meier analysis (p = 0.007, log-rank test). Univariate Cox proportional hazard regression analyses revealed that a higher total emphysema score (>3.0) was a significantly poor prognostic factor in addition to Krebs von den Lungen-6, surfactant protein-D, arterial oxygen tension, percent forced vital capacity, and percent diffusing capacity of carbon monoxide (%DLCO). Multivariate Cox proportional hazard regression analyses with the stepwise method showed that higher total emphysema score (>3) and %DLCO were significantly poor prognostic factors.
  
  
  CONCLUSIONS
  The prognosis of IPF-emphysema was significantly worse than that of IPF alone.
authors: Department of Internal Medicine, National Hospital Organization, Kinki-Chuo Chest Medical Center, Osaka, Japan.
authors: Yasuo
authors: Y
authors: Kohashi
authors: Toru
authors: T
authors: Arai
authors: Chikatoshi
authors: C
authors: Sugimoto
authors: Kazunobu
authors: K
authors: Tachibana
authors: Masanori
authors: M
authors: Akira
authors: Masanori
authors: M
authors: Kitaichi
authors: Seiji
authors: S
authors: Hayashi
authors: Yoshikazu
authors: Y
authors: Inoue
mesh_terms: D000368:Aged; D001706:Biopsy; D001784:Blood Gas Analysis; D002248:Carbon Monoxide; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018396:Mucin-1 / Q000378:metabolism; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011653:Pulmonary Diffusing Capacity; D011656:Pulmonary Emphysema / Q000150:complications / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D037663:Pulmonary Surfactant-Associated Protein D / Q000378:metabolism; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity
chemical_list: C060192:MUC1 protein, human; D018396:Mucin-1; D037663:Pulmonary Surfactant-Associated Protein D; D002248:Carbon Monoxide