Title |
Survival in Idiopathic pulmonary fibrosis acute exacerbations: the non-steroid approach
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Published in |
BMC Pulmonary Medicine, December 2015
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DOI | 10.1186/s12890-015-0146-4 |
Pubmed ID | |
Authors |
Spyros A Papiris, Konstantinos Kagouridis, Likurgos Kolilekas, Andriana I Papaioannou, Aneza Roussou, Christina Triantafillidou, Katerina Baou, Katerina Malagari, Stylianos Argentos, Anastasia Kotanidou, Anna Karakatsani, Effrosyni D Manali |
Abstract |
Idiopathic pulmonary fibrosis acute exacerbation (IPF-AE) constitutes IPF's most devastating event, representing the unexpected superimposition of diffuse alveolar damage of unknown etiology. Guidelines recommend high-dose steroids treatment despite unproven benefit. We hypothesized that previous immunosuppression and the administration of high-dose steroids adversely affect IPF-AE outcome. We studied all consecutive patients hospitalized in our department for IPF deterioration from 2007 to June 2013. Our protocol consisted of immediate cessation of immunosuppression (if any), best supportive care, broad-spectrum antimicrobials and thorough evaluation to detect reversible causes of deterioration. Patients were followed-up for survival; post-discharge none received immunosuppression. Twenty-four out of 85 admissions (28 %) fulfilled IPF-AE criteria. IPF-AE were analyzed both as unique events and as unique patients. As unique events 50 % survived; 3 out of 12 (25 %) in the group previously treated with immunosuppression whereas nine out of 12 (75 %) in the group not receiving immunosuppression (p = 0.041). As unique patients 35.3 % survived; 3 out of 6 (50 %) in the never treated group whereas three out of 11 (27.3 %) in the group receiving immunosuppression (p = 0.685). The history of immunosuppression significantly and adversely influenced survival (p = 0.035). Survival was greater in the never treated group compared to the immunosuppressed patients (p = 0.022). Post-discharge, our IPF-AE survivors had an 83 % 1-year survival. By applying the above mentioned protocol half of our patients survived. The history of immunosuppression before IPF-AE adversely influences survival. Avoiding steroids in IPF patients may favor the natural history of the disease even at the moment of its most devastating event. |
X Demographics
Geographical breakdown
Country | Count | As % |
---|---|---|
United States | 4 | 16% |
Venezuela, Bolivarian Republic of | 2 | 8% |
Canada | 2 | 8% |
Mexico | 1 | 4% |
Kuwait | 1 | 4% |
Spain | 1 | 4% |
United Kingdom | 1 | 4% |
Guinea | 1 | 4% |
Unknown | 12 | 48% |
Demographic breakdown
Type | Count | As % |
---|---|---|
Members of the public | 15 | 60% |
Practitioners (doctors, other healthcare professionals) | 5 | 20% |
Scientists | 5 | 20% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 54 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Researcher | 8 | 15% |
Other | 7 | 13% |
Student > Doctoral Student | 5 | 9% |
Student > Ph. D. Student | 5 | 9% |
Professor > Associate Professor | 5 | 9% |
Other | 10 | 19% |
Unknown | 14 | 26% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 26 | 48% |
Business, Management and Accounting | 3 | 6% |
Biochemistry, Genetics and Molecular Biology | 2 | 4% |
Arts and Humanities | 2 | 4% |
Pharmacology, Toxicology and Pharmaceutical Science | 1 | 2% |
Other | 4 | 7% |
Unknown | 16 | 30% |