Improved Prognostic Prediction by Combination of Early Initiation of Polymyxin B Hemoperfusion with Modified Gender-Age-Physiology Index in Acute Exacerbation of Idiopathic Pulmonary Fibrosis
Improved Prognostic Prediction by Combination of Early Initiation of Polymyxin B Hemoperfusion with Modified Gender-Age-Physiology Index in Acute Exacerbation of Idiopathic Pulmonary Fibrosis
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早期开始多粘菌素 B 血液灌流与改良性别年龄生理指数相结合可改善特发性肺纤维化急性加重的预后预测
DOI：
10.1159/000518705
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发表时间：
2022
影响因子：
3
通讯作者：
Matsunaga Kazuto
中科院分区：
文献类型：
--
作者：
Oishi Keiji;Azuma Arata;Abe Shinji;Murata Yoriyuki;Sakamoto Kenji;Mimura Yusuke;Asami-Noyama Maki;Kakugawa Tomoyuki;Hirano Tsunahiko;Matsunaga Kazuto
特发性肺纤维化急性加重期(AE-IPF)所致的呼吸衰竭与高死亡率相关。多粘菌素B固定化纤维柱(PMX-DHP)直接血液灌流对AE-IPF患者有良好的治疗效果。患者特征是否影响这一益处的程度尚不清楚。方法我们回顾了30例接受PMX-DHP的AE-IPF患者的记录。结果PMX-DHP术后1个月和12个月生存率分别为70.0%和50.0%。多因素分析显示，较低的改良性别-年龄-生理(GAP)指数(≤8分)(危险比[HR]0.317，p=0.015)和在激素冲击后48 h内接受PMXDHP治疗(HR 0.289，p=0.012)是有利因素。值得注意的是，即使在改良GAP指数较高的患者，即较晚期的IPF患者中，激素冲击后48h内接受PMX-DHP治疗的患者的预后也好于激素冲击后48h后的患者(p=0.032)。结论在AE-IPF患者中早期启动PMX-DHP，尤其是在激素治疗后48h内启动PMX-DHP，无论AE-IPF前IPF慢性期的严重程度如何，都可以改善预后。
IntroductionRespiratory failure from acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is associated with high mortality. Direct hemoperfusion with polymyxin B-immobilized fiber column (PMX-DHP) has been reported to have beneficial effects on patients with AE-IPF. Whether patient characteristics influence the extent of this benefit remains unclear.MethodsWe retrospectively examined the records of 30 patients with AE-IPF who underwent PMX-DHP. The favorable factors of survival were determined using Cox proportional hazards analyses.ResultsThe 1-and 12-month survival rates after PMX-DHP were 70.0% and 50.0%, respectively. The multivariate analysis revealed that low modified Gender-Age-Physiology (GAP) index (≤ 8 points)(hazard ratio [HR] 0.317, p= 0.015) and PMX-DHP received within 48 h of steroid pulse (HR 0.289, p= 0.012) were favorable factors. Notably, even in the patients with high modified GAP index (> 8 points), that is, more advanced IPF, those who received PMX-DHP within 48 h of steroid pulse had a better prognosis than those who did after 48 h of the steroid pulse (p= 0.032).ConclusionsEarly PMX-DHP initiation in patients with AE-IPF, specifically within 48 h after the steroid pulse therapy, may improve prognosis regardless of the severity of chronic phase of IPF before AE-IPF.
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DOI：
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发表时间：
2007
期刊：
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DOI：
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发表时间：
2016
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影响因子：
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作者：
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