A new study published in Respiratory Investigation suggests that the cross-sectional area (CSA) of the erector spinae muscle (ESMCSA) visualized on single-slice computed tomography (CT) could be a potential prognostic factor for acute exacerbations (AE) of idiopathic pulmonary fibrosis (IPF).

The conclusion was drawn from the analysis of a cohort of patients with hospital admission due to AE-IPF, showing that a low ESMCSA was associated with a high 90-day mortality rate.

“Considering our results and previous literature, skeletal muscle atrophy at any time may correlate with a poor prognosis in patients with IPF. Early and aggressive intervention is important for patients diagnosed with IPF because they frequently present with skeletal muscle atrophy during the disease course,” the study’s authors said.

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In the study, patients with AE-IPF who presented with low ESMCSA (<25.6 cm2) had a significantly worse prognosis than those with high ESMCSA (≥25.6 cm2). Moreover, low ESMCSA in patients with AE-IPF was identified as a potential risk factor for all-cause mortality.

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Conversely, the study did not find any association between low CSA of the pectoralis muscle (PMCSA) on CT and poor prognosis in AE-IPF.

The study included 212 patients presenting with AE-IPF in 8 hospitals from Japan, as assessed using an algorithm based on the International Statistical Classification of Diseases and Related Health Problems, 10th Revision.

The general study cohort was assigned to ESMCSA (n=212) and PMCSA (n=207) groups. Each group was further classified into low (low ESMCSA, n=122, low PMCSA, n=51) and high (high ESMCSA, n=90, high PMCSA, n=156) subgroups.

Previous studies have suggested that the analysis of the CSA of skeletal muscle in a single transverse section of a CT scan can be used to estimate skeletal muscle mass in lung diseases. Both the ESMCSA and the PMCSA are visualized on the transverse sections of a routine chest CT scan.


Ito Y, Anan K, Awano N, et al. Skeletal muscle atrophy and short-term mortality in patients with acute exacerbation of idiopathic pulmonary fibrosis: an observational cohort study. Respir Investig. Published online April 18, 2023. doi:10.1016/j.resinv.2023.02.010