Abstract
Introduction: Acute exacerbation (AE) of idiopathic interstitial pneumonias (IIPs) is a topic for recent years. We have shown that diffuse pattern of high resolution CT (HRCT) at AE of idiopathic pulmonary fibrosis (IPF) is a worse prognostic factor (Akira, AJRCCM 2008). Prognostic significance of serum levels of KL-6 and surfactant protein (SP)-D in AE of IIPs has not been clarified sufficiently.
Aim: We examined clinical findings in AE of IIPs retrospectively to clarify the significance of serum KL-6 and SP-D as a prognostic factor.
Subjects: Seventy cases of AE of IIPs were diagnosed according to the guideline of Japanese Respiratory Society in 2004 and classified with radiological and/or pathological findings into two groups: IPF (n=55) and non-IPF (n=15).
Method: Serum levels of KL-6 and SP-D were compared between 30days survivors and non-survivors. Prognostic factors determining 30days survival was examined by logistic regression analysis among various clinical parameters including serum markers, HRCT patterns at AE (diffuse/non-diffuse).
Results: Serum SP-D levels of 30days survivors at AE were significantly less than that of non-survivors, however, there was no difference in serum KL-6 levels. Serum KL-6 of patients with diffuse pattern was significantly lower than that of patients with non-diffuse pattern. Logistic analysis revealed that serum KL-6 at AE, white blood cell counts, immunoglobulin G, gender, complication of diabetes meritus and pre-treatment before AE were significant factors determining 30days survival.
Conclusions: Serum KL-6 (>1450U/ml) is a significant worse prognostic factor determining 30 days survival in AE of IIPs.
- © 2011 ERS