We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Efficacy of concurrent treatments in idiopathic pulmonary fibrosis patients with a rapid progression of respiratory failure: an analysis of a national administrative database in Japan.
- Authors
Keishi Oda; Kazuhiro Yatera; Yoshihisa Fujino; Hiroshi Ishimoto; Hiroyuki Nakao; Tetsuya Hanaka; Takaaki Ogoshi; Takashi Kido; Kiyohide Fushimi; Shinya Matsuda; Hiroshi Mukae; Oda, Keishi; Yatera, Kazuhiro; Fujino, Yoshihisa; Ishimoto, Hiroshi; Nakao, Hiroyuki; Hanaka, Tetsuya; Ogoshi, Takaaki; Kido, Takashi; Fushimi, Kiyohide
- Abstract
<bold>Background: </bold>Some IPF patients show a rapid progression of respiratory failure. Most patients are treated with high-dose corticosteroids. However, no large clinical studies have investigated the prognosis or efficacy of combined treatments including high-dose corticosteroids in IPF patients with a rapid progression of respiratory failure.<bold>Methods: </bold>We enrolled IPF patients who received mechanical ventilation and high-dose corticosteroids between April 2010 and March 2013. Records were extracted from a Japanese nationwide inpatient database. We conducted a retrospective epidemiologic and prognostic analysis.<bold>Results: </bold>Two hundred nine patients receiving an average of 12.8 days of ventilatory support were enrolled. There were 138 (66 %) fatal cases; the median survival was 21 days. The short-term (within 30 days) and long-term (within 90 days) survival rates were 44.6 and 24.6 %, respectively. The average monthly admission rate among the IPF patients with the rapid progression of respiratory failure in the winter was significantly higher than that in spring (p = 0.018). Survival did not differ to a statistically significant extent in the different geographic areas of Japan. Survivors were significantly younger (p = 0.002) with higher rates of mild dyspnea on admission (p = 0.012), they more frequently underwent bronchoscopy (p < 0.001), and received anticoagulants (p = 0.027), co-trimoxazole (p < 0.001) and macrolide (p = 0.02) more frequently than non-survivors. A multivariate logistic analysis demonstrated that two factors were significantly associated with a poor prognosis: >80 years of age (OR = 2.94, 95 % Cl 1.044-8.303; p = 0.041) and the intravenous administration of high-dose cyclophosphamide (OR = 3.17, 95 % Cl 1.101-9.148; p = 0.033). Undergoing bronchoscopy during intubation (OR = 0.25, 95 % Cl 0.079-0.798; p = 0.019) and the administration of co-trimoxazole (OR = 0.28, 95 % Cl 0.132-0.607; p = 0.001) and macrolides (OR = 0.37, 95 % Cl 0.155-0.867; p = 0.033) were significantly associated with a good prognosis. The dosage of co-trimoxazole significantly correlated with survival.<bold>Conclusions: </bold>Co-trimoxazole and macrolides may be a good addition to high-dose corticosteroids in the treatment of IPF patients with a rapid progression of respiratory failure.
- Subjects
JAPAN; DISEASE exacerbation; IDIOPATHIC pulmonary fibrosis; ARTIFICIAL respiration; ADRENOCORTICAL hormones; CO-trimoxazole; MACROLIDE antibiotics; RESPIRATORY distress syndrome; THERAPEUTICS; RESPIRATORY insufficiency treatment; BRONCHOSCOPY; DATABASES; INTENSIVE care units; MULTIVARIATE analysis; PROGNOSIS; RESPIRATORY insufficiency; SURVIVAL; LOGISTIC regression analysis; TREATMENT effectiveness; RETROSPECTIVE studies; DISEASE progression; KAPLAN-Meier estimator; DISEASE complications
- Publication
BMC Pulmonary Medicine, 2016, Vol 16, p1
- ISSN
1471-2466
- Publication type
journal article
- DOI
10.1186/s12890-016-0253-x