Diffuse Lung Disease: Care of the Patient with IPF |

The Impact of Comorbidities on Idiopathic Pulmonary Fibrosis Outcomes FREE TO VIEW

Roozbeh Sharif, MD; Aline Zouk, MD; Tejaswini Kulkarni, MD; Pilar Acosta, MD; Tracy Luckhardt, MD; Victor Thannickal, MD; Joao Alberto de Andrade, MD
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University of Alabama at Birmingham, Birmingham, AL

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):471A. doi:10.1016/j.chest.2016.08.485
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SESSION TITLE: Care of the Patient with IPF

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 26, 2016 at 08:45 AM - 10:00 AM

PURPOSE: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fatal lung disease characterized by UIP pattern in chest high resolution CT scan and/or lung biopsy. Available therapies have not demonstrated a survival benefit. Patients with IPF are older and may have several comorbidities, however, the impact of these conditions on the prognosis of the disease has not been investigated. We aimed to examine the impact of comorbidities on survival among patients with IPF at a tertiary academic medical center. Our hypothesis was that patients with more comorbidities have shorter survival, independent of age and IPF severity.

METHODS: In a retrospective cohort study, all patients diagnosed with IPF between January 2000 and March 2014 at a tertiary academic medical center were reviewed by at least two study investigators. Those who met the 2011 American Thoracic Society criteria were enrolled. Demographic and clinical variables were obtained. Primary outcome was defined as transplant-free survival. The baseline forced vital capacity (FVC) and diffusion capacity (DLCO) percent predicted value for each patient were calculated. Comorbidities were included based on Charlson Comorbidity Index (CCI). Using Cox regression analysis, we examined the impact of number of comorbidities on transplant-free survival, adjusting for age, sex, and disease severity.

RESULTS: Out of 352 patients included in the study, 111 (31.5%) were female. Average age (±SD) was 65.7 (4.3).73 (20.7%) patients had no comorbidities, while 113 (32.1%) had one, 96 (27.3%) had two and 70 (19.9%) patients had three or more comorbidities. The univariable Cox-regression analysis indicated that the number of comorbidities is associated with transplant-free survival (HR: 1.09; 95%CI: 1.01, 1.2, p-value=0.034). After adjusting for age, sex, and severity of disease (based on FVC percent predicted value), for each additional comorbidity, risk of mortality increases by 10%. Hence, we categorize the cohort into four groups. Observed mortality was 26%, 24%, 21%, and 13% for patients with none, one, two, and three or more comorbidities, respectively. The major change noted when patients had two or more comorbidities. Furthermore, multivariable analysis showed patients with two or more comorbidities (compared to those with one or none) have 30% higher risk of mortality (HR: 1.29, 95%CI: 1.02, 1.66, p-value=0.035).

CONCLUSIONS: Among patients with IPF, regardless of severity of disease, the number of comorbidities is associated with worse prognosis independent of demographics and baseline disease severity indices.

CLINICAL IMPLICATIONS: Significant impact of comorbid conditions on the disease survival underscores the pivotal role of multidisciplinary approach in disease management. In addition, the comorbid conditions should be considered in risk stratification for clinical trials enrollment.

DISCLOSURE: The following authors have nothing to disclose: Roozbeh Sharif, Aline Zouk, Tejaswini Kulkarni, Pilar Acosta, Tracy Luckhardt, Victor Thannickal, Joao Alberto de Andrade

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