In patients who experience acute exacerbations of idiopathic pulmonary fibrosis (IPF), scores on the quick Sequential Organ Failure Assessment (qSOFA) and the Japanese Association for Acute Medicine-Disseminated Intravascular Coagulation (JAAM-DIC) are significant predictors of in-hospital mortality, according to findings from a retrospective Japanese study published in Respiratory Investigation.
Although many individuals with IPF exhibit a slowly progressive disease course, some patients do develop acute respiratory deterioration, which is known as acute exacerbation. With high mortality rates after these acute exacerbations of IPF, evaluating an individual’s prognosis following such an event is critical.
The researchers sought to explore the use of qSOFA, compared with other composite assessments such as the JAAM-DIC, to predict mortality in patients with acute exacerbations of IPF. The qSOFA was originally designed to detect patients at risk of developing sepsis.
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The study included 97 patients—78 men and 19 women—with IPF who had been admitted for an acute exacerbation at Kindai University Hospital between January 2008 and December 2019. Among these individuals, 69.1% (67 of 97) were discharged alive and 30.9% (30 of 97) died.
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Following hospital admission, 87.6% (85 of 97) of the participants received methylprednisolone pulse therapy. Of note, all of the patients who were not treated with methylprednisolone pulse therapy were discharged alive.
Per multivariate logistic regression analysis, after adjusting for partial pressure of arterial oxygen/fraction of inspiratory oxygen (PaO2/FiO2) ratios, both the qSOFA and JAAM-DIC scores were significant predictors of mortality (odds ratio [OR], 3.86; 95% CI, 1.43-10.3; P =.007 and OR, 2.71; 95% CI, 1.56-4.67; P =.0004, respectively).
As the score on the qSOFA or the JAAM-DIC increased, hospital mortality rates rose as well. The area under the receiver operating characteristic curves of the qSOFA and JAAM-DIC scores for prediction of hospital mortality were 0.71 (95% CI, 0.66-0.72) and 0.78 (95% CI, 0.78-0.84), respectively.
Higher qSOFA and JAAM-DIC scores at hospitalization were significantly associated with worse survival (log rank, P =.0002 and P =.0005, respectively). Estimated median survival times from the date of hospital admission in patients with qSOFA scores of 0, 1, and 2 were 1114, 333, and 4 days, respectively. In contrast, estimated median survival times in patients with JAAM-DIC scores of 0, 1, and 2 were 837, 519, and 37 days, respectively.
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Further, the sum of the qSOFA and JAAM-DIC scores was significantly more effective at predicting mortality than the individual scores (OR, 3.30; 95% CI, 1.73-6.33; P =.0003).
The authors noted that both the qSOFA score and the JAAM-DIC score also predicted patients’ long-term survival. “The qSOFA score plus the JAAM-DIC score should be determined as part of the diagnostic evaluation of a patient with [acute exacerbation of] IPF to predict the patient’s mortality,” they concluded.
Reference
Yamazaki R, Nishiyama O, Yoshikawa K, Tohda Y, Matsumoto H. Prognostic value of the qSOFA in patients with acute exacerbation of idiopathic pulmonary fibrosis. Respir Investig. Published online March 16, 2023. doi:10.1016/j.resinv.2023.02.006
