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Jouneau S, Rousseau C, Lederlin M, Lescoat A, Kerjouan M, Chauvin P, Luque-Paz D, Guillot S, Oger E, Vernhet L, Thibault. R. Malnutrition and decreased food intake at diagnosis are associated with hospitalization and mortality of idiopathic pulmonary fibrosis patients. Clin Nutr 2022; 41:1335-1342. [DOI: 10.1016/j.clnu.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/06/2022] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
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Cottin V, Spagnolo P, Bonniaud P, Nolin M, Dalon F, Kirchgässler KU, Kamath TV, Van Ganse E, Belhassen M. Mortality and Respiratory-Related Hospitalizations in Idiopathic Pulmonary Fibrosis Not Treated With Antifibrotics. Front Med (Lausanne) 2022; 8:802989. [PMID: 35004781 PMCID: PMC8739228 DOI: 10.3389/fmed.2021.802989] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Real-world data regarding outcomes of idiopathic pulmonary fibrosis (IPF) are scarce, outside of registries. The claims data from the French National Health System (SNDS) were used to describe outcomes in patients diagnosed with IPF in 2015–2016 but who did not receive antifibrotic therapies. Method: Patients aged <50 years were excluded, as were patients with pulmonary fibrosis other than IPF, patients who had previously received a lung transplant, and those who had received antifibrotic therapies at any time between 2010 and 2016. Patients were followed-up until their last health record, lung transplantation, initiation of antifibrotic therapies, death, or the end of the study period (31 December 2017), whichever occurred first. Results: A total of 5,360 patients (43.2%) not treated with antifibrotic therapies were included. The mean age was 75.5 years, and 57.9% were males. In the year before inclusion, 47.3% of patients had a Charlson score ≥5. During follow-up, 41.2% of patients died. The unadjusted incidence rate was 29.9 per 100 person-years (95%CI = [28.7–31.2]), and the cumulative incidence of death at 3 years was 50.2% (95% CI = [48.3–52.1%]). In the study population, 35.3% of patients experienced an acute respiratory-related hospitalization. The unadjusted incidence rate was 32.1 per 100 person-years (95%CI = [30.6–33.5]) and the cumulative incidence of the event at 3 years was 41.5% (95% CI = [39.7–43.2%]). Interpretation: This observational study showed that, if untreated with antifibrotics, IPF is associated with a 50% all-cause mortality at 3 years. These figures can serve as a historical control of the natural course of the disease.
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Affiliation(s)
- Vincent Cottin
- National French Reference Coordinating Center for Rare Pulmonary Diseases, Louis Pradel Hospital and Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, INRAE, IVPC, ERN-LUNG, Lyon, France
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Philippe Bonniaud
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre de Référence Constitutif des Maladies Pulmonaires Rares de l'Adulte, Centre Hospitalo-Universitaire de Bourgogne and Faculté de Médecine et Pharmacie, Université de Bourgogne-Franche Comté, Dijon, France.,INSERM U123-1, Dijon, France
| | - Maëva Nolin
- PharmacoEpidemiology Lyon (PELyon), Lyon, France
| | | | | | | | - Eric Van Ganse
- PharmacoEpidemiology Lyon (PELyon), Lyon, France.,Respiratory Medicine, Croix Rousse University Hospital and Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
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Touil I, Keskes Boudawara N, Bouchareb S, Ben Saad A, Migaou A, Cheikh Mhamed S, Fahem N, Mribah H, Knani J, Boussoffara L, Rouatbi N, Joobeur S. [Prognostic factors in idiopathic pulmonary fibrosis in a tunisian cohort]. Rev Mal Respir 2021; 38:681-688. [PMID: 33992493 DOI: 10.1016/j.rmr.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
We present data on prognostic factors in a Tunisian cohort of people with Idiopathic pulmonary fibrosis. INTRODUCTION Idiopathic pulmonary fibrosis (IPF) has a poor prognosis, with a median survival in patients with the condition of only 3 to 5 years. Previous studies have identified a number of prognostic factors in this chronic pulmonary disease. METHODS We conducted a retrospective study, including patients with idiopathic pulmonary fibrosis (IPF) who were diagnosed at the Pneumology Department of the University Hospital Fattouma-Bourguiba, Monastir, between 1991 and 2014. The aim of this study was to compare clinical, radiological, pulmonary functional predictors of survival in IPF in a Tunisian cohort with those of previous studies. RESULTS This study included 126 patients. Their mean age was 66 years, with a male predominance (68.3%). Respiratory function tests revealed a restrictive ventilatory deficit in 72.6% of cases. The median survival of our study population was 22.5 months [6.7-49.5]. In univariate analysis, factors associated with a poor prognosis were: lower baseline values of TLC, FCV and DLco, level of dyspnea assessed by mMRC scale, hypoxemia at diagnosis, the degree of desaturation during exercise, a higher annual decline of FVC and DLco, acute respiratory distress and also the GAP score. In multivariate analysis, independent prognostic factors were: baseline DLco, level of dyspnea, desaturation at exertion and the annual decline of the DLco. CONCLUSION Lower baseline DLco, the level of dyspnea, desaturation on exercise, and annual decline in DLco are all associated with a poor prognosis in IPF.
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Affiliation(s)
- I Touil
- Service de pneumologie, hôpital Tahar-Sfar de Mahdia, avenue Taher SfarVlle Mahdia, 5100 Tunisie.
| | - N Keskes Boudawara
- Service de pneumologie, hôpital Tahar-Sfar de Mahdia, avenue Taher SfarVlle Mahdia, 5100 Tunisie
| | - S Bouchareb
- Service de pneumologie, hôpital Tahar-Sfar de Mahdia, avenue Taher SfarVlle Mahdia, 5100 Tunisie
| | - A Ben Saad
- Service de pneumologie, hôpital Fattouma-Bourguiba-Monastir, 5000 Tunisie
| | - A Migaou
- Service de pneumologie, hôpital Fattouma-Bourguiba-Monastir, 5000 Tunisie
| | - S Cheikh Mhamed
- Service de pneumologie, hôpital Fattouma-Bourguiba-Monastir, 5000 Tunisie
| | - N Fahem
- Service de pneumologie, hôpital Fattouma-Bourguiba-Monastir, 5000 Tunisie
| | - H Mribah
- Service de pneumologie, hôpital Fattouma-Bourguiba-Monastir, 5000 Tunisie
| | - J Knani
- Service de pneumologie, hôpital Tahar-Sfar de Mahdia, avenue Taher SfarVlle Mahdia, 5100 Tunisie
| | - L Boussoffara
- Service de pneumologie, hôpital Tahar-Sfar de Mahdia, avenue Taher SfarVlle Mahdia, 5100 Tunisie
| | - N Rouatbi
- Service de pneumologie, hôpital Fattouma-Bourguiba-Monastir, 5000 Tunisie
| | - S Joobeur
- Service de pneumologie, hôpital Fattouma-Bourguiba-Monastir, 5000 Tunisie
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Diridollou T, Sohier L, Rousseau C, Angibaud A, Chauvin P, Gaignon T, Tas M, Lemerre J, Kerjouan M, Salé A, Lederlin M, Jouneau S. Idiopathic pulmonary fibrosis: Significance of the usual interstitial pneumonia (UIP) CT-scan patterns defined in new international guidelines. Respir Med Res 2020; 77:72-78. [PMID: 32416587 DOI: 10.1016/j.resmer.2020.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The new 2018 international guidelines for diagnosing usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) by CT scan split the old pattern possible UIP (2011 IPF guidelines) into two new patterns: probable UIP and indeterminate for UIP. However, the proportions and prognoses of these new CT-scan patterns are not clear. METHODS We used a monocentric retrospective cohort of 322 patients suspected of having IPF (University Hospital of Rennes; Competence Center for Rare Lung Diseases; 1 January 2012-31 December 2017). All patients initially diagnosed by CT scan as possible UIP were included. The chest CT-scans were then reclassified according to the new 2018 international guidelines by 3 observers. These data were then subjected to survival analysis with multivariate Cox regression using a composite endpoint of death, lung transplantation, a decline of≥10% in forced vital capacity (FVC), or hospitalization. RESULTS Of the 89 possible UIP patients included, 74 (83%) were reclassified as probable UIP and 15 (17%) as indeterminate for UIP. Probable UIP patients were more likely to meet the composite endpoint (56/74 [75.7%] vs. 5/15 [33%] patients; HR [IC 95%] =3.12 [1.24; 7.83], P=0.015). Multivariate analysis indicated that the probable UIP pattern was associated with significantly increased risk of reaching the composite endpoint (HR [95% CI]=2.85[1.00; 8.10], P=0.049). CONCLUSION The majority of possible UIP diagnoses corresponded to probable UIP, which was associated with a significantly worse prognosis than indeterminate for UIP. This distinction between these two CT patterns emphasizes the relevance of the new international guidelines for the diagnosis of IPF.
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Affiliation(s)
- T Diridollou
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France.
| | - L Sohier
- Service de pneumologie, centre hospitalier Lorient, Lorient, France
| | - C Rousseau
- Centre d'investigation clinique, Inserm 1414, Rennes, France
| | - A Angibaud
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - P Chauvin
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - T Gaignon
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - M Tas
- Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France
| | - J Lemerre
- Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France
| | - M Kerjouan
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - A Salé
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France
| | - M Lederlin
- Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France
| | - S Jouneau
- Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France; Service de pneumologie, centre hospitalier Lorient, Lorient, France; Centre d'investigation clinique, Inserm 1414, Rennes, France; Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France; UMR1085, IRSET, université de Rennes 1, Rennes, France.
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Fernandes L, Nasser M, Ahmad K, Cottin V. Interstitial Pneumonia With Autoimmune Features (IPAF). Front Med (Lausanne) 2019; 6:209. [PMID: 31681774 PMCID: PMC6798044 DOI: 10.3389/fmed.2019.00209] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/09/2019] [Indexed: 11/13/2022] Open
Abstract
A significant proportion of patients with interstitial lung disease (ILD) manifest autoimmune features, but do not fulfill the diagnostic criteria for a definite connective tissue disease (CTD). In 2015, the European Respiratory Society (ERS) and American Thoracic Society (ATS) “Task Force on undifferentiated Forms of connective tissue disease-associated interstitial lung disease” proposed classification criteria for a so-called research category of Interstitial Pneumonia with Autoimmune Features (IPAF). These classification criteria were based on a combination of features from three domains: a clinical domain consisting of extra-thoracic features; a serologic domain with specific autoantibodies; and a morphologic domain with imaging patterns, histopathological findings or multi-compartment involvement. Patients meeting IPAF criteria tend to have a history of smoking similar to patients with idiopathic pulmonary fibrosis. The most frequent clinical and serological markers of autoimmune features are Raynaud' phenomenon and positive antinuclear antibodies, respectively. Non-specific interstitial pneumonia is the predominant radiologic and histopathologic pattern, although patients meeting IPAF criteria through the clinical and serologic domains may also have a usual interstitial pneumonia pattern. Management should be carefully individualized on a case-by-case basis in keeping with the wide heterogeneity of IPAF and lack of evidence in this particular subgroup of patients. Prognosis is generally intermediate between that of idiopathic pulmonary fibrosis and connective tissue disease-associated interstitial lung disease, but substantially variable according to the predominant histologic and radiologic patterns. As acknowledged by the Task Force, the proposed classification scheme of IPAF is a research concept that will need revision and refinement based on data to better inform prognostication and patient care.
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Affiliation(s)
- Ligia Fernandes
- Departamento do Tórax, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Mouhamad Nasser
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
| | - Kais Ahmad
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France
| | - Vincent Cottin
- Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Hospices Civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, University of Lyon, INRA, UMR754, Lyon, France
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