Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/34796
Title: Prognostic factors associated with mortality in acute exacerbations of idiopathic pulmonary fibrosis: A systematic review and meta-analysis.
Austin Authors: Pitre, Tyler;Lupas, Daniel;Ebeido, Ibrahim;Colak, Alexander;Modi, Mihir;Kachkovski, George V;Montesi, Sydney B;Khor, Yet H ;Kawano-Dourado, Leticia;Jenkins, Gisli;Fisher, Jolene H;Shapera, Shane;Rochwerg, Bram;Couban, Rachel;Zeraatkar, Dena
Affiliation: Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Faculty of Medicine, University of British Columbia, BC, Canada.
Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA.
Institute for Breathing and Sleep
Hcor Research Institute, Hospital do Coracao, Sao Paulo, Brazil; Pulmonary Division, University of Sao Paulo, Sao Paulo, Brazil; MAGIC Evidence Ecosystem, Oslo, Norway.
Margaret Turner Warwick Centre for Fibrosing Lung Disease, National Heart and Lung Institute, Imperial College London, UK.
Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada; Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Department of Anesthesiology, McMaster University, Hamilton, ON, Canada.
Department of Medicine, McMaster University, Hamilton, ON, Canada; Department of Anesthesiology, McMaster University, Hamilton, ON, Canada.
Issue Date: Feb-2024
Date: 2023
Publication information: Respiratory Medicine 2024-02; 222
Abstract: Acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF) increases mortality risk, but which factors increase mortality is unknown. We aimed to perform a prognostic review of factors associated with mortality in patients with IPF. and methods: We searched MEDLINE, EMBASE, and CINAHL for studies that reported on the association between any prognostic factor and AE-IPF. We assessed risk of bias using the QUIPS tool. We conduced pairwise meta-analyses using REML heterogeneity estimator, and GRADE approach to assess the certainty of the evidence. We included 35 studies in our analysis. We found that long-term supplemental oxygen at baseline (aHR 2.52 [95 % CI 1.68 to 3.80]; moderate certainty) and a diagnosis of IPF compared to non-IPF ILD (aHR 2.19 [95 % CI 1.22 to 3.92]; moderate certainty) is associated with a higher risk of death in patients with AE-IPF. A diffuse pattern on high resolution computed tomography (HRCT) compared to a non-diffuse pattern (aHR 2.61 [95 % CI 1.32 to 2.90]; moderate certainty) is associated with a higher risk of death in patients with AE-IPF. We found that using corticosteroids prior to hospital admission (aHR 2.19 [95 % CI 1.26 to 3.82]; moderate certainty) and those with increased neutrophils (by % increase) in bronchoalveolar lavage (BAL) during the exacerbation is associated with a higher risk of death (aHR 1.02 [1.01 to 1.04]; moderate certainty). Our results have implications for healthcare providers in making treatment decisions and prognosticating the clinical trajectory of patients, for researchers to design future interventions to improve patient trajectory, and for guideline developers in making decisions about resource allocation.
URI: https://ahro.austin.org.au/austinjspui/handle/1/34796
DOI: 10.1016/j.rmed.2023.107515
ORCID: 
Journal: Respiratory Medicine
Start page: 107515
PubMed URL: 38154738
ISSN: 1532-3064
Type: Journal Article
Subjects: Acute exacerbations
IPF
Meta-analysis
Prognostic factors
Appears in Collections:Journal articles

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