Baseline High-Resolution CT Findings Predict Acute Exacerbation of Idiopathic Pulmonary Fibrosis: German and Japanese Cohort Study

Chihiro Hirano; Shinichiro Ohshimo; Yasushi Horimasu; Hiroshi Iwamoto; Kazunori Fujitaka; Hironobu Hamada; Nobuoki Kohno; Daisuke Komoto; Kazuo Awai; Nobuaki Shime; Francesco Bonella; Josune Guzman; Hilmar Kühl; Ulrich Costabel; Noboru Hattori

doi:10.3390/jcm8122069

Baseline High-Resolution CT Findings Predict Acute Exacerbation of Idiopathic Pulmonary Fibrosis: German and Japanese Cohort Study

J Clin Med. 2019 Nov 24;8(12):2069. doi: 10.3390/jcm8122069.

Authors

Chihiro Hirano¹, Shinichiro Ohshimo^{1

2}, Yasushi Horimasu¹, Hiroshi Iwamoto¹, Kazunori Fujitaka¹, Hironobu Hamada¹, Nobuoki Kohno^{1

3}, Daisuke Komoto^{4

5}, Kazuo Awai⁴, Nobuaki Shime², Francesco Bonella⁶, Josune Guzman⁷, Hilmar Kühl⁸, Ulrich Costabel⁶, Noboru Hattori¹

Affiliations

¹ Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
² Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-7551, Japan.
³ Hiroshima Cosmopolitan University, Hiroshima 734-0014, Japan.
⁴ Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
⁵ Department of Diagnostic Radiology, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Hiroshima 737-0023, Japan.
⁶ Interstitial and Rare Lung Disease Unit, Department of Pneumology, Ruhrlandklinik, University Hospital Essen, 45239 Essen, Germany.
⁷ General and Experimental Pathology, Ruhr University Bochum, 44801 Bochum, Germany.
⁸ Department of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen, 45147 Essen, Germany.

Abstract

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a major cause of morbidity and death in IPF. However, sensitive predictive factors of AE-IPF have not been well-investigated. To investigate whether high-resolution computed tomographic (HRCT) abnormalities predict AE-IPF in independent ethnic cohorts, this study included 121 patients with IPF (54 German and 67 Japanese; mean age, 68.5 ± 7.6 years). Two radiologists independently visually assessed the presence and extent of lung abnormalities in each patient. Twenty-two (18.2%) patients experienced AE-IPF during the follow-up. The incidence of AE-IPF was significantly higher in the Japanese patients (n = 18, 26.9%) than in the German patients (n = 4, 7.3%, p < 0.01). In the Kaplan-Meier analysis, patients with a larger extent of ground glass opacity (GGO), fibrosis, and traction bronchiectasis experienced an earlier onset of AE-IPF (p = 0.0033, 0.0088, and 0.049, respectively). In the multivariate analysis, a larger extent of GGO and fibrosis on HRCT were independent predictors of AE-IPF (p = 0.026 and 0.037, respectively). Additionally, Japanese ethnicity was independently associated with the incidence of AE-IPF after adjustment for HRCT findings (p = 0.0074). In conclusion, a larger extent of GGO and fibrosis on HRCT and Japanese ethnicity appear to be risk factors for AE-IPF.

Keywords: acute exacerbation (AE); ethnicity; ground glass opacity (GGO); high-resolution computed tomography (HRCT); idiopathic pulmonary fibrosis (IPF).