Abstract | BACKGROUND: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis and there is currently no effective treatment for this condition. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) improves oxygenation, but it is unclear whether treatment of AE-IPF with PMX-DHP affects survival. This study elucidated the effectiveness and safety of PMX-DHP for the treatment of AE-IPF. METHODS: This study included 31 patients with 41 episodes of AE-IPF. All patients received steroids. Of 31, 14 patients (20 episodes) were treated with PMX-DHP. The laboratory and physiological test results after the start of therapy and survival were retrospectively compared between patients treated with and without PMX-DHP. RESULTS: Patients treated with PMX-DHP had a significantly greater change in PaO2/FiO2 ratio (mean ± SEM, 58.2 ± 22.5 vs. 0.7 ± 13.3, p = 0.034) and a smaller change in white blood cell count (-630 ± 959 /μL vs. 4500 ± 1190 /μL, p = 0.002) after 2 days of treatment than patients treated without PMX-DHP. The 12-month survival rate was significantly higher in patients treated with PMX-DHP (48.2% vs. 5.9%, p = 0.041). PMX-DHP was effective in patients with more severe underlying disease (GAP stages II or III; 12-month survival rate 57.1% with PMX-DHP vs. 0% without PMX-DHP, p = 0.021). Treatment with PMX-DHP was an independent predictor of better prognosis (hazard ratio 0.345, p = 0.037). Mild pulmonary thromboembolism occurred in one patient treated with PMX-DHP. CONCLUSIONS: Treatment of AE-IPF with PMX-DHP is tolerable and improves 12-month survival.
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Authors | Noriyuki Enomoto, Masashi Mikamo, Yoshiyuki Oyama, Masato Kono, Dai Hashimoto, Tomoyuki Fujisawa, Naoki Inui, Yutaro Nakamura, Hideo Yasuda, Akihiko Kato, Soichiro Mimuro, Matsuyuki Doi, Shigehito Sato, Takafumi Suda |
Journal | BMC pulmonary medicine
(BMC Pulm Med)
Vol. 15
Pg. 15
(Feb 22 2015)
ISSN: 1471-2466 [Electronic] England |
PMID | 25887940
(Publication Type: Clinical Study, Journal Article)
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Chemical References |
- Anti-Bacterial Agents
- Immobilized Proteins
- Polymyxin B
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Topics |
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents
(therapeutic use)
- Disease Progression
- Female
- Hemoperfusion
(methods)
- Humans
- Idiopathic Pulmonary Fibrosis
(immunology, therapy)
- Immobilized Proteins
(therapeutic use)
- Leukocyte Count
- Longitudinal Studies
- Male
- Middle Aged
- Polymyxin B
(therapeutic use)
- Prognosis
- Proportional Hazards Models
- Retrospective Studies
- Survival Rate
- Treatment Outcome
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