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Acute exacerbation of idiopathic pulmonary fibrosis: high-resolution CT scores predict mortality

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Abstract

Objectives

To determine high-resolution computed tomography (HRCT) findings helpful in predicting mortality in patients with acute exacerbation of idiopathic pulmonary fibrosis (AEx-IPF).

Methods

Sixty patients with diagnosis of AEx-IPF were reviewed retrospectively. Two groups (two observers each) independently evaluated pattern, distribution, and extent of HRCT findings at presentation and calculated an HRCT score at AEx based on normal attenuation areas and extent of abnormalities, such as areas of ground-glass attenuation and/or consolidation with or without traction bronchiectasis or bronchiolectasis and areas of honeycombing. The correlation between the clinical data including the HRCT score and mortality (cause-specific survival) was evaluated using the univariate and multivariate Cox-regression analyses.

Results

Serum KL-6 level, PaCO2, and the HRCT score were statistically significant predictors on univariate analysis. Multivariate analysis revealed that the HRCT score was an independently significant predictor of outcome (hazard ratio, 1.13; 95% confidence interval, 1.06–1.19, P = 0.0002). The area under receiver operating characteristics curve for the HRCT score was statistically significant in the classification of survivors or nonsurvivors (0.944; P < 0.0001). Survival in patients with HRCT score ≥245 was worse than those with lower score (log-rank test, P < 0.0001).

Conclusion

The HRCT score at AEx is independently related to prognosis in patients with AEx-IPF.

Key Points

•High-Resolution Computed Tomography (HRCT) helps clinicians to assess patients with interstitial fibrosis.

•The main abnormalities of acute exacerbation are ground-glass opacification and consolidation.

•Extent of abnormalities on HRCT correlates with poor prognosis.

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Acknowledgements

This study was partially supported by a Grant to the Diffuse Lung Disease Group from the Ministry of Health, Labour and Welfare (Japan).

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Authors and Affiliations

  1. Department of Radiology, Kurume University School of Medicine, and Center for Diagnostic Imaging, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan

    Kiminori Fujimoto

  2. Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Aichi, Japan

    Hiroyuki Taniguchi, Yasuhiro Kondoh & Kensuke Kataoka

  3. Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Itami, Japan

    Takeshi Johkoh

  4. Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan

    Kazuya Ichikado

  5. Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan

    Hiromitsu Sumikawa

  6. Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan

    Takashi Ogura & Takahiro Endo

  7. Biostatistics Center, Kurume University School of Medicine, Kurume, Japan

    Atsushi Kawaguchi

  8. Department of Radiology, University of British Columbia and Vancouver General Hospital, Vancouver, B.C., Canada

    Nestor L. Müller

Authors
  1. Kiminori Fujimoto
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  2. Hiroyuki Taniguchi
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  3. Takeshi Johkoh
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  4. Yasuhiro Kondoh
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  5. Kazuya Ichikado
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  6. Hiromitsu Sumikawa
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  7. Takashi Ogura
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  8. Kensuke Kataoka
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  9. Takahiro Endo
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  10. Atsushi Kawaguchi
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  11. Nestor L. Müller
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Corresponding author

Correspondence to Kiminori Fujimoto.

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Fujimoto, K., Taniguchi, H., Johkoh, T. et al. Acute exacerbation of idiopathic pulmonary fibrosis: high-resolution CT scores predict mortality. Eur Radiol 22, 83–92 (2012). https://doi.org/10.1007/s00330-011-2211-6

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  • DOI: https://doi.org/10.1007/s00330-011-2211-6

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