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Original Research: INTERSTITIAL LUNG DISEASE |

Serum Surfactant Protein-A Is a Strong Predictor of Early Mortality in Idiopathic Pulmonary Fibrosis

Brent W. Kinder, MD; Kevin K. Brown, MD, FCCP; Francis X. McCormack, MD, FCCP; Joachim H. Ix, MD; Alma Kervitsky, BS; Marvin I. Schwarz, MD, FCCP; Talmadge E. King, Jr, MD, FCCP
Author and Funding Information

*From the Division of Pulmonary, Critical Care, and Sleep Medicine (Drs. Kinder and McCormack), Department of Medicine, University of Cincinnati College of Medicine; Cincinnati, OH; the Department of Medicine (Drs. Brown and Schwarz, and Ms. Kervitsky), National Jewish Medical and Research Center, Denver, CO; the Division of Nephrology and Hypertension (Dr. Ix), Department of Medicine, University of California San Diego, San Diego, CA; and the Department of Medicine (Dr. King), University of California, San Francisco School of Medicine, San Francisco, CA.

Correspondence to: Brent W. Kinder, MD, University of Cincinnati College of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 231 Albert Sabin Way, ML 0564, Cincinnati, OH 45267; e-mail: brent.kinder@uc.edu


This work was supported by a National Institutes of HealthT32 training grant and a Clinical Research Loan Repayment Grant (to Dr. Kinder); National Heart, Lung, and Blood Institute Specialized Center of Research (SCOR) grants No. HL-27353 and No. HL-67671; and a Dean's Scholars Clinical Research grant from the University of Cincinnati (to Dr. Kinder).

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(6):1557-1563. doi:10.1378/chest.08-2209
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Background:  Serum surfactant protein (SP) A and SP-D had prognostic value for mortality in patients with idiopathic pulmonary fibrosis (IPF) in prior studies before the reclassification of the idiopathic interstitial pneumonias. We hypothesized that baseline serum SP-A and SP-D concentrations would be independently associated with mortality among patients with biopsy-proven IPF and would improve a prediction model for mortality.

Methods:  We evaluated the association between serum SP-A and SP-D concentrations and mortality in 82 patients with surgical lung biopsy-proven IPF. Regression models with clinical predictors alone and clinical and biomarker predictors were used to predict mortality at 1 year.

Results:  After controlling for known clinical predictors of mortality, we found that each increase of 49 ng/mL (1 SD) in baseline SP-A level was associated with a 3.3-fold increased risk of mortality (adjusted hazard ratio, 3.27; 95% confidence interval, 1.49 to 7.17; adjusted p = 0.003) in the first year after presentation. We did not observe a statistically significant association between serum SP-D and mortality (adjusted hazard ratio, 2.04; p = 0.053). Regression models demonstrated a significant improvement in the 1-year mortality prediction model when serum SP-A and SP-D (area under the receiving operator curve [AROC], 0.89) were added to the clinical predictors alone (AROC, 0.79; p = 0.03).

Conclusions:  Increased serum SP-A level is a strong and independent predictor of early mortality among patients with IPF. A prediction model containing SP-A and SP-D was substantially superior to a model with clinical predictors alone.

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