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Survival in IPF acute exacerbations: The non-steroid approach

Spyros Papiris, Konstantinos Kagouridis, Likurgos Kolilekas, Aneza Roussou, Christina Triantafillidou, Katerina Baou, Anastasia Papaporfyriou, Georgia Papadaki, Kostas Vougas, Katerina Malagari, Stelios Loukides, Anastasia Kotanidou, Anna Karakatsani, Effrosyni Manali
European Respiratory Journal 2013 42: P463; DOI:
Spyros Papiris
12nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Konstantinos Kagouridis
12nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Likurgos Kolilekas
27th Pulmonary Department, Sotiria Chest Diseases Hospital, Athens, Greece
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Aneza Roussou
12nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Christina Triantafillidou
36th Pulmonary Department, Sotiria Chest Diseases Hospital, Athens, Greece
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Katerina Baou
44th Pulmonary Department, Sotiria Chest Diseases Hospital, Athens, Greece
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Anastasia Papaporfyriou
12nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Georgia Papadaki
12nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Kostas Vougas
5Genomics and Proteomics Research Units, Center of Basic Research II, Biomedical Research Foundation, Academy of Athens, Athens, Greece
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Katerina Malagari
6Imaging and Research Unit, Evgenidion University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Stelios Loukides
12nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Anastasia Kotanidou
71st Department of Critical Care, Evangelismos Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Anna Karakatsani
12nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Effrosyni Manali
12nd Pulmonary Medicine Department, Attikon University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Abstract

Background

IPF acute exacerbations (IPF-AE) have no proven etiology and although they represent the development of diffuse alveolar damage upon usual interstitial pneumonia, international guidelines recommend high dose steroids. However, the prognosis remains unacceptably dismal.

Aims and objectives

Assuming that IPF-AE is an ARDS of unknown cause we tested the hypothesis whether ARDS treatment and withdrawing or withholding immunosuppression plus broad spectrum antibiotics influence survival (Papiris et al AJRCCM 2012;185:587-8)

Methods

We studied patients hospitalized in our clinic from 2007 to 2012 with IPF deterioration. Our protocol consists of immediate cessation of immunosuppression (if any), best supportive care, broad spectrum antibiotics and thorough evaluation to detect reversible causes of respiratory deterioration. All patients were followed up for survival; after discharge none received immunosuppression. We analyzed our data using logistic regression analysis.

Results

Out of 77 admissions, after excluding other causes of deterioration such as respiratory infection, heart failure, sepsis, pulmonary embolism, pneumothorax, disease progression or progression to the final end, 22 (29%) fulfilled IPF-AE criteria. Among them 50% survived; 3 out of 11 (27%) survived in the group previously receiving immunosuppression whereas 8 out of 11 (73%) in the group not receiving immunosuppression (p=0.033). The median survival of IPF-AE survivors was 11.5 months.

Conclusions

Survival of patients treated with the non-steroid approach is better than published data. Previous treatment with immunosuppression is related with increased mortality. No administration of immunosuppression post-discharge is related with prolonged survival.

  • ARDS (Acute Respiratory Distress Syndrome)
  • Interstitial lung disease
  • Immunosuppression
  • © 2013 ERS
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Survival in IPF acute exacerbations: The non-steroid approach
Spyros Papiris, Konstantinos Kagouridis, Likurgos Kolilekas, Aneza Roussou, Christina Triantafillidou, Katerina Baou, Anastasia Papaporfyriou, Georgia Papadaki, Kostas Vougas, Katerina Malagari, Stelios Loukides, Anastasia Kotanidou, Anna Karakatsani, Effrosyni Manali
European Respiratory Journal Sep 2013, 42 (Suppl 57) P463;

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Survival in IPF acute exacerbations: The non-steroid approach
Spyros Papiris, Konstantinos Kagouridis, Likurgos Kolilekas, Aneza Roussou, Christina Triantafillidou, Katerina Baou, Anastasia Papaporfyriou, Georgia Papadaki, Kostas Vougas, Katerina Malagari, Stelios Loukides, Anastasia Kotanidou, Anna Karakatsani, Effrosyni Manali
European Respiratory Journal Sep 2013, 42 (Suppl 57) P463;
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