The following is a summary of “Prognostic factors associated with mortality in acute exacerbations of idiopathic pulmonary fibrosis: A systematic review and meta-analysis,” published in the February 2024 issue of Pulmonology by Pitre, et al.
Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) pose a significant risk of mortality, yet the factors contributing to increased mortality remain uncertain. For a study, researchers sought to conduct a prognostic review of factors associated with mortality in patients with IPF.
A comprehensive search of MEDLINE, EMBASE, and CINAHL was conducted to identify studies reporting the association between prognostic factors and AE-IPF. The risk of bias was assessed using the QUIPS tool. Pairwise meta-analyses were performed using the REML heterogeneity estimator, and the GRADE approach was used to evaluate the certainty of the evidence.
A total of 35 studies were included in the analysis. Long-term supplemental oxygen at baseline (aHR 2.52 [95 % CI 1.68 to 3.80]; moderate certainty) and a diagnosis of IPF compared to non-IPF ILD (aHR 2.19 [95 % CI 1.22 to 3.92]; moderate certainty) were associated with a higher risk of death in AE-IPF patients. A diffuse pattern on high-resolution computed tomography (HRCT) compared to a non-diffuse pattern (aHR 2.61 [95 % CI 1.32 to 2.90]; moderate certainty) was also linked to increased mortality in AE-IPF patients. Additionally, corticosteroid use before hospital admission (aHR 2.19 [95 % CI 1.26 to 3.82]; moderate certainty) and increased neutrophil levels in bronchoalveolar lavage (BAL) during exacerbation (aHR 1.02 [1.01 to 1.04]; moderate certainty) were associated with a higher risk of death.
The findings had important implications for healthcare providers in treatment decision-making and prognostication for patients with AE-IPF. They also informed researchers in designing interventions to improve patient outcomes and guide guideline developers in resource allocation decisions.
Reference: resmedjournal.com/article/S0954-6111(23)00403-1/abstract