Yoshinari Nakatsuka1, Tomohiro Handa1, Maria Kokosi2, Kiminobu Tanizawa1, Silvia Puglisi2, Joseph Jacob3,4, Akihiko Sokai5, Kohei Ikezoe1, Kumiko T Kanatani6, Takeshi Kubo7, Hiromi Tomioka8, Yoshio Taguchi9, Sonoko Nagai10, Kazuo Chin11, Michiaki Mishima12, Athol U Wells2, Toyohiro Hirai1. 1. Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 2. Royal Brompton Hospital, London, United Kingdom. 3. Department of Respiratory Medicine, University College London, London, United Kingdom. 4. Centre for Medical Image Computing, University College London, London, United Kingdom. 5. Department of Respiratory Medicine, Takatsuki Red Cross Hospital, Takatsuki, Japan. 6. School of Public Health, Kyoto University, Kyoto, Japan. 7. Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 8. Department of Respiratory Medicine, Kobe City Medical Center West Hospital, Kobe, Japan. 9. Department of Respiratory Medicine, Tenri Hospital, Nara, Japan. 10. Kyoto Central Clinic Clinical Research Center, Kyoto, Japan. 11. Department of Respiratory Care and Sleep Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 12. Saiseikai Noe Hospital, Osaka, Japan.
Abstract
BACKGROUND: The significance of the nutritional status in idiopathic pulmonary fibrosis (IPF) is largely unknown. Temporal body weight (BW) change, a dynamic index of nutrition status, can detect the malnutrition more accurately than the conventional single-point body mass index evaluation. OBJECTIVE: To investigate how the temporal BW change influences the clinical courses of IPF. METHODS: This multicenter study enrolled IPF patients from four referral hospitals of interstitial lung diseases in Japan (the Japanese cohort, the derivation cohort) and the Royal Brompton Hospital (the UK cohort, the validation cohort). The annual rate of BW change from the initial presentation was evaluated. A > 5% decrease of BW was defined as a significant BW loss. RESULTS: Twenty-seven out of 124 patients in the Japanese cohort and 13 out of 86 patients in the UK cohort showed significant BW loss. Patients with BW loss showed significantly worse survival in both cohorts. Multivariate analyses revealed that BW loss was an independent factor for decreased survival (Japanese cohort: p = 0.047, UK cohort: p = 0.013). A 6.1% loss of BW was chosen as the optimal cutoff value to predict the 2-year mortality from the initial presentation. The stratified analysis revealed that a 6.1% or greater BW loss could predict worse survival specifically in cases without a greater than 10% decline in forced vital capacity (FVC). CONCLUSIONS: BW loss is independently associated with the survival of IPF patients, particularly when a decline in the FVC was not observed. Further studies are needed to understand the mechanisms underlying BW loss in IPF.
BACKGROUND: The significance of the nutritional status in idiopathic pulmonary fibrosis (IPF) is largely unknown. Temporal body weight (BW) change, a dynamic index of nutrition status, can detect the malnutrition more accurately than the conventional single-point body mass index evaluation. OBJECTIVE: To investigate how the temporal BW change influences the clinical courses of IPF. METHODS: This multicenter study enrolled IPF patients from four referral hospitals of interstitial lung diseases in Japan (the Japanese cohort, the derivation cohort) and the Royal Brompton Hospital (the UK cohort, the validation cohort). The annual rate of BW change from the initial presentation was evaluated. A > 5% decrease of BW was defined as a significant BW loss. RESULTS: Twenty-seven out of 124 patients in the Japanese cohort and 13 out of 86 patients in the UK cohort showed significant BW loss. Patients with BW loss showed significantly worse survival in both cohorts. Multivariate analyses revealed that BW loss was an independent factor for decreased survival (Japanese cohort: p = 0.047, UK cohort: p = 0.013). A 6.1% loss of BW was chosen as the optimal cutoff value to predict the 2-year mortality from the initial presentation. The stratified analysis revealed that a 6.1% or greater BW loss could predict worse survival specifically in cases without a greater than 10% decline in forced vital capacity (FVC). CONCLUSIONS: BW loss is independently associated with the survival of IPF patients, particularly when a decline in the FVC was not observed. Further studies are needed to understand the mechanisms underlying BW loss in IPF.
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Authors: Tejaswini Kulkarni; Kaiyu Yuan; Thi K Tran-Nguyen; Young-Il Kim; Joao A de Andrade; Tracy Luckhardt; Vincent G Valentine; Daniel J Kass; Steven R Duncan Journal: PLoS One Date: 2019-10-04 Impact factor: 3.240