Quantitative HRCT-Derived Fibrosis Burden as an Independent Predictor of Mortality in Patients with Idiopathic...

Objectives: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with increasing prevalence and mortality. High-resolution computed tomography (HRCT) is routinely performed in IPF assessment and can provide additional quantitative information. However, the prognostic utility of these HRCT-based parameters in IPF remains uncertain. This study aimed to investigate the prognostic value of quantitative HRCT findings in predicting mortality among patients with IPF. Methods: In this retrospective cohort study, 48 patients diagnosed with IPF between 2014 and 2024 were analyzed. Demographics, pulmonary function tests, HRCT findings, and quantitative measurements, including coronary artery calcium (CAC) score; densities of hepatic, paraspinal muscle, and lumbar vertebral bone mineral; and HRCT-derived fibrosis scores, were collected at baseline and after at least two years. The primary outcome was all-cause mortality. Results: The mean age was 66.8 ± 8.5 years; 77.1% were male. During a median follow-up of 63.3 months, 22 patients (45.8%) died, mainly from IPF-related causes (71.4%). Non-survivors had significantly higher HRCT fibrosis scores both at diagnosis (p = 0.006) and at two years (p = 0.002). Fibrosis scores increased significantly over time in non-survivors (p = 0.019). CAC scores rose in both groups, with a greater increase in non-survivors, but their independent prognostic value was limited after adjustment. Multivariable analysis identified male sex (hazard ratio [HR]: 5.46, p = 0.031) and second-year fibrosis score (HR: 1.10, p < 0.001) as independent predictors of mortality. Conclusions: HRCT-derived fibrosis burden is an independent predictor of mortality in IPF, alongside male sex. While other HRCT-based measures showed limited prognostic significance, longitudinal increases in CAC scores suggested potential cardiovascular implications.