title: Survival from an Acute Exacerbation of Idiopathic Pulmonary Fibrosis with or without Direct Hemoperfusion with a Polymyxin B-immobilized Fiber Column: A Retrospective Analysis.
abstract: Objective Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) are fatal episodes of acute respiratory worsening of unknown etiology. Previous studies on acute respiratory distress syndrome have shown that direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) can have a beneficial effect on the respiratory status. This retrospective study investigated the prognosis and survival outcome of patients with AE-IPF who underwent PMX-DHP. Methods We examined the records of 50 patients with AE-IPF treated in our hospital. All patients received corticosteroid pulse therapy. We compared the disease outcome between 27 patients who underwent PMX-DHP (PMX group) and 23 patients who did not (non-PMX group). The independent predictors of survival were determined using Cox proportional hazards analyses. Results A multivariate analysis of all patients revealed that PMX-DHP therapy was a significant predictor of survival (HR=0.442, 95% CI 0.223-0.873; p=0.019). The 12-month survival rate was significantly higher in the PMX group than in the non-PMX group (41.7% vs. 9.8%; p=0.040). According to a subanalysis of the PMX group, the time from AE-IPF onset to PMX-DHP was a significant predictor of survival (HR=1.080, 95% CI 1.001-1.166; p=0.049). Conclusion PMX-DHP improved the prognosis of AE-IPF. The time from AE-IPF onset to PMX-DHP may therefore be informative for predicting the patient outcome.
authors.affiliation: Department of Respiratory Medicine, National Hospital Organization Yamaguchi-Ube Medical Center, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Oishi
authors.forename: Keisuke
authors.initials: K
authors.lastname: Aoe
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Mimura
authors.forename: Yoriyuki
authors.initials: Y
authors.lastname: Murata
authors.forename: Kenji
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Wataru
authors.initials: W
authors.lastname: Koutoku
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ueoka
authors.forename: Masafumi
authors.initials: M
authors.lastname: Yano
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018450:Disease Progression; D005260:Female; D006464:Hemoperfusion / Q000379:methods* / Q000401:mortality; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011112:Polymyxin B / Q000627:therapeutic use*; D011379:Prognosis; D012128:Respiratory Distress Syndrome / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D011112:Polymyxin B