Parameters predicting mortality in antifibrotic-treated IPF patients: mMRC, CPI, TLCO, FVC, GAP

Idiopathic pulmonary fibrosis(IPF) continues to be a fatal disease despite the use of antifibrotic therapy. There is limited data on the prognostic importance of parameters predicting mortality. We aimed to identify independent mortality predictors in antifibrotic-treated IPF patients.

With ethics committee approval, IPF patients receiving consecutively antifibrotic treatment between 1 January 2013-01.01.2023 at Izmir Dr Suat Seren Chest Disease and Surgery Training and Research Hospital were retrospectively screened. The clinical-demographic-radiologic data were recorded. Cox regression and Kaplan-Meier analyses explored associations with mortality; receiver-operating-characteristic (ROC) curves defined optimal cutoffs.

The mean age of 381 patients was 68.8 ± 7.8 years. 87% (n = 331) was male. 1-3-5-10 year mortality rates were 8.1%-28.9%-41.7%-47.2%, respectively. In the multivariate regression analysis, the following were identified as independent predictors of increased mortality risk: Symptom progression (Hazard Ratio(HR)=1.64, 95%Confidence Interval (CI):1.13-2.37, p = 0.008), mMRC >2 (HR = 1.62, 95%CI:1.13-2.32, p = 0.009), presence of radiologically honeycombing (HR = 1.91, 95%CI:1.21-3.02, p = 0.006), CPI >49.2 (HR = 1.60, 95% CI:1.15-2.22, p = 0.005), FVC ≤71% (HR = 1.41, 95% CI:1.00-1.99, p = 0.048).

Patients with symptom progression, mMRC >2, presence of honeycombing on radiological imaging, FVC ≤71%, and CPI >49.2 have a higher risk of mortality and should be referred for pulmonary rehabilitation and lung transplantation evaluation at an early stage.