Nobuyasu Awano1, Minoru Inomata2, Naoyuki Kuse3, Mari Tone4, Hanako Yoshimura5, Tatsunori Jo6, Kohei Takada7, Chikatoshi Sugimoto8, Tomonori Tanaka9, Hiromitsu Sumikawa10, Yuzo Suzuki11, Tomoyuki Fujisawa12, Takafumi Suda13, Takehiro Izumo14. 1. Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: awanobu0606@hotmail.co.jp. 2. Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: inomataminoru@nms.ac.jp. 3. Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: nao-k-u@nms.ac.jp. 4. Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: m.tone.0829@gmail.com. 5. Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: mimi-divamariah@live.jp. 6. Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: jotatsunori@gmail.com. 7. Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: koheitakada1021@gmail.com. 8. Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8555, Japan. Electronic address: sugimoto@kch.hosp.go.jp. 9. Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. Electronic address: tanaka.t.tomonori@gmail.com. 10. Department of Radiology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, 593-8304, Japan. Electronic address: h-sumikawa@radiol.med.osaka-u.ac.jp. 11. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Hamadayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. Electronic address: yuzosuzu@hama-med.ac.jp. 12. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Hamadayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. Electronic address: fujisawa@hama-med.ac.jp. 13. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Hamadayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. Electronic address: suda@hama-med.ac.jp. 14. Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: drtake1118@gmail.com.
Abstract
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive disease often accompanied by skeletal muscle wasting. We investigated whether skeletal muscle mass and muscle attenuation on computed tomography (CT) are predictors of mortality in IPF patients, using a nationwide cloud-based database and web-based multidisciplinary discussion (MDD) system. METHODS: IPF patients diagnosed using MDD from April 2009 to March 2014 were included. We analyzed the cross-sectional area (CSA) of the erector spinae muscle (ESMCSA) and the pectoralis muscle (PMCSA), muscle attenuation of the ESM (ESMMA), and PM (PMMA) on single-slice axial CT. Survival probability was assessed using the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox proportional hazards models were used to evaluate the relationship among the ESMCSA, PMCSA, ESMMA, PMMA, clinical parameters, and prognosis. RESULTS: A total of 199 IPF patients were enrolled. Seventy-four patients died during the study period and the most frequent cause was acute exacerbation (13.1%). The group with the lowest quartile of ESMCSA had significantly worse survival than other groups (P = 0.009). Survival rates of the groups with the lowest quartile of PMCSA, lower ESMMA, and lower PMMA did not differ from those of other groups. According to multivariate analysis, ESMCSA < lower quartile was significantly associated with all-cause mortality (hazards ratio, 1.96; P = 0.030), whereas, ESMMA < median, PMCSA < lower quartile, and PMMA < median were not. CONCLUSIONS: Low ESMCSA on CT images may be a strong risk factor for all-cause mortality in IPF patients based on MDD diagnosis.
BACKGROUND:Idiopathic pulmonary fibrosis (IPF) is a progressive disease often accompanied by skeletal muscle wasting. We investigated whether skeletal muscle mass and muscle attenuation on computed tomography (CT) are predictors of mortality in IPFpatients, using a nationwide cloud-based database and web-based multidisciplinary discussion (MDD) system. METHODS:IPFpatients diagnosed using MDD from April 2009 to March 2014 were included. We analyzed the cross-sectional area (CSA) of the erector spinae muscle (ESMCSA) and the pectoralis muscle (PMCSA), muscle attenuation of the ESM (ESMMA), and PM (PMMA) on single-slice axial CT. Survival probability was assessed using the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox proportional hazards models were used to evaluate the relationship among the ESMCSA, PMCSA, ESMMA, PMMA, clinical parameters, and prognosis. RESULTS: A total of 199 IPFpatients were enrolled. Seventy-four patients died during the study period and the most frequent cause was acute exacerbation (13.1%). The group with the lowest quartile of ESMCSA had significantly worse survival than other groups (P = 0.009). Survival rates of the groups with the lowest quartile of PMCSA, lower ESMMA, and lower PMMA did not differ from those of other groups. According to multivariate analysis, ESMCSA < lower quartile was significantly associated with all-cause mortality (hazards ratio, 1.96; P = 0.030), whereas, ESMMA < median, PMCSA < lower quartile, and PMMA < median were not. CONCLUSIONS: Low ESMCSA on CT images may be a strong risk factor for all-cause mortality in IPFpatients based on MDD diagnosis.