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Comorbidity burden and survival in patients with idiopathic pulmonary fibrosis: a real-world cohort study
Qinxue Shen1, Shiting Zhou2, Xiaoli Ouyang1
1Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China; Research Unit of Respiratory Disease, Central South University, Changsha, Hunan 410011, China; The Clinical Medical Research Center for Pulmonary and Critical Care Medicine in Hunan Province, 410011, China; Diagnosis and Treatment Center of Respiratory Disease, Central South University, Changsha, Hunan 410011, China.
Background:
Idiopathic pulmonary fibrosis (IPF) is a progressive disease that predominantly affects older adults and is frequently accompanied by multiple chronic comorbidities. Although individual comorbidities have been widely reported, the prognostic impact of cumulative comorbidity burden in routine clinical practice remains incompletely understood.
Objectives:
To investigate the prevalence of comorbidities in patients with IPF and to evaluate the association between comorbidity burden and all-cause mortality in a real-world clinical cohort.
Methods:
We conducted a retrospective cohort study including 328 patients with IPF diagnosed between 2011 and 2021 at the Second Xiangya Hospital. Comorbidities were systematically assessed at baseline and quantified using a structured comorbidity index. Associations between comorbidity burden and all-cause mortality were evaluated using Cox proportional hazards models and Kaplan-Meier survival analysis, with follow-up until May 2022.
Results:
Among the 328 patients, 78.7% had at least one comorbidity at baseline, and >60% had two or more comorbidities. Cardiovascular disease (32.6%), hyperlipidemia (26.5%), hypertension (25.9%), and diabetes (16.4%) were the most common conditions. In multivariable analysis, higher comorbidity burden was independently associated with increased mortality. Patients with ≥2 comorbidities had significantly shorter survival compared with those with 0-1 comorbidity (log-rank P < 0.001). Cardiovascular disease and diabetes were significant predictors of adverse outcomes.
Conclusion:
In this real-world IPF cohort, comorbidities were common and associated with reduced survival. Assessment of comorbidity burden provides complementary prognostic information beyond traditional pulmonary parameters and supports a more holistic approach to risk stratification in IPF.
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