The natural history of idiopathic pulmonary fibrosis in a large European population: the role of age, sex and comorbidities
The natural history of idiopathic pulmonary fibrosis in a large European population: the role of age, sex and comorbidities
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DOI：
10.1007/s11739-021-02651-w
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发表时间：
2021-02-14
影响因子：
4.6
通讯作者：
Harari, Sergio
中科院分区：
文献类型：
--
作者：
Caminati, Antonella;Madotto, Fabiana;Harari, Sergio
临床试验的安慰剂组提供了研究特发性肺纤维化（IPF）自然史的机会，但这些患者并不能代表真实的IPF人群。本文的目的是评价突发IPF病例的患者特征及其对死亡率和住院风险的影响。我们使用2000年至2010年行政数据库的数据进行了一项回顾性队列研究。根据文献中报告的不同算法，识别了IPF事件病例。我们应用考克斯比例风险模型来评估患者的特征、死亡率和住院之间的关系。根据三种病例定义，我们确定了2338、460和1704例新发IPF病例。诊断时的平均年龄约为72岁，男性比例在59%至62%之间，至少患有一种慢性疾病的患者在70%至74%之间。年龄、男性和合并症与不良结局相关。充血性心力衰竭（CHF）、糖尿病和癌症是与死亡率相关的疾病，而与住院相关的疾病是CHF和慢性阻塞性肺病。我们的数据源提供了一个最大的样本，长期随访期的cardiac患者。使用文献中提出和验证的不同算法，我们观察到IPF患者的死亡率和住院率较高，年龄、性别和合并症显著影响临床结局。即使在调整了年龄和合并症后，女性也显示出明显的生存优势。患有既存疾病的患者，特别是患有肺和心血管疾病的患者风险更高。
Placebo arms of clinical trials provide an opportunity to investigate the natural history of idiopathic pulmonary fibrosis (IPF) but these patients are not representative of the real life IPF population. Objective of this article is to evaluate patients' characteristics of incident IPF cases and their impact on mortality and hospitalizations risk. We conducted a retrospective cohort study using data from administrative databases from 2000 to 2010. Based on different algorithms reported in literature, incident IPF cases were identified. We applied Cox proportional hazards models to assess relationship between patients' characteristics, mortality and hospitalization. According to three case definitions, we identified 2338, 460 and 1704 incident IPF cases. Mean age at diagnosis was about 72 years, the proportion of male varied between 59 and 62% and patients with at least one chronic disease were between 70 and 74%. Age, male sex and comorbidities were associated to worse outcomes. Congestive heart failure (CHF), diabetes and cancer were conditions associated to mortality, while those associated to hospitalization were CHF and chronic obstructive pulmonary disease. Our data source provided one of the largest samples of unselected patients with a long follow-up period. Using different algorithms proposed and validated in literature, we observed that mortality and hospitalization rate are high in patients with IPF and age, sex and comorbidities significantly affect clinical outcomes. Females show a significant survival advantage over males, even after adjusting for age and comorbidities. Patients with pre-existing diseases, especially those with pulmonary and cardiovascular diseases are at higher risk.