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A7472 - Prednisolone Really Increases the Frequency of Acute Exacerbation in IPF and IIPs with Possible UIP HRCT Pattern?
Author Block: T. Arai1, T. Kagawa1, Y. Sasaki1, R. Sugawara1, C. Sugimoto1, K. Tachibana1, M. Kitaichi2, M. Akira1, S. Hayashi3, Y. Inoue1; 1Clinical Research Center, NHO Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan, 2Department of Pathology, NHO Minami Wakayama Medical Center, Tanabe, Wakayama, Japan, 3Department of Internal Medicine, NHO Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan.
[Introduction] We have examined predictive factors of acute exacerbation (AE) in idiopathic interstitial pneumonias (IIPs) and usage of prednisolone (PSL) was not a risk factor for AE in total IIP cases. Whether PSL usage is a risk factor of AE-IPF or not is not clarified yet. Most of IIPs cases with possible usual interstitial pneumonia (UIP) HRCT pattern (possible UIP cases) were reported to be IPF. [Subjects and Methods] From 2005 to 2009, 231 cases were diagnosed as IIPs with the findings of bronchoscopic examination and two cases of IIPs with AE at the diagnosis of IIPs were excluded. Out of the 229 cases, 92 IPF cases diagnosed according to the ATS/ERS/JRS/ALAT guideline and 74 possible UIP cases were included in this examination. AE was diagnosed according to the Japanese Respiratory Society. AE occurred in 29 IPF cases and 12 possible UIP cases. Risk factors of AE were examined by univariate and multivariate Cox proportional hazard regression analysis. [Results] Out of the 166 cases (IPF/possible UIP cases: 92/74 cases), 34 cases (18/16cases, respectively) were treated with PSL for the chronic deterioration. At the diagnosis of IPF/possible UIP cases, % predictive value of forced vital capacity (%FVC) and %predictive value of diffusing capacity of carbon monoxide (%DLco) was significantly lower and serum levels of Krebs von den lungen-6 and surfactant protein-D was significantly higher in PSL-treated cases than that in PSL-non-treated cases by Wilcoxon rank sum test. PSL therapy for chronic deterioration was a significant predictor of AE in possible UIP cases and total cases; however, it was not significant in IPF cases. For total cases, lower %FVC, higher body mass index, higher modified Medical Research Council score (>2) was significant predictor of AE by multivariate analysis. After the adjustment with these three factors, PSL therapy for chronic deterioration was not a predictor of AE for total cases (p=0.840), IPF cases (p=0.749) and possible UIP cases (p=0.661). [Conclusions] We have shown the possibility that increase in AE in IPF and possible UIP cases were caused not by PSL treatment itself, but by respiratory dysfunction observed in PSL-treated cases. [Financial Supports] This study was partially supported by a grant from the National Hospital Organization {H28-NHO (Kokyu)-2} awarded to T. Arai and Y. Inoue, and AMED: DLD/14526278 and PAP/14526182 awarded to Y. Inoue and Y. Inoue and T. Arai, respectively.