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Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival
BACKGROUND: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis and there is currently no effective treatment for this condition. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) improves oxygenation, but it is unclear whether treatm...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349669/ https://www.ncbi.nlm.nih.gov/pubmed/25887940 http://dx.doi.org/10.1186/s12890-015-0004-4 |
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author | Enomoto, Noriyuki Mikamo, Masashi Oyama, Yoshiyuki Kono, Masato Hashimoto, Dai Fujisawa, Tomoyuki Inui, Naoki Nakamura, Yutaro Yasuda, Hideo Kato, Akihiko Mimuro, Soichiro Doi, Matsuyuki Sato, Shigehito Suda, Takafumi |
author_facet | Enomoto, Noriyuki Mikamo, Masashi Oyama, Yoshiyuki Kono, Masato Hashimoto, Dai Fujisawa, Tomoyuki Inui, Naoki Nakamura, Yutaro Yasuda, Hideo Kato, Akihiko Mimuro, Soichiro Doi, Matsuyuki Sato, Shigehito Suda, Takafumi |
author_sort | Enomoto, Noriyuki |
collection | PubMed |
description | BACKGROUND: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis and there is currently no effective treatment for this condition. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) improves oxygenation, but it is unclear whether treatment of AE-IPF with PMX-DHP affects survival. This study elucidated the effectiveness and safety of PMX-DHP for the treatment of AE-IPF. METHODS: This study included 31 patients with 41 episodes of AE-IPF. All patients received steroids. Of 31, 14 patients (20 episodes) were treated with PMX-DHP. The laboratory and physiological test results after the start of therapy and survival were retrospectively compared between patients treated with and without PMX-DHP. RESULTS: Patients treated with PMX-DHP had a significantly greater change in PaO(2)/FiO(2) ratio (mean ± SEM, 58.2 ± 22.5 vs. 0.7 ± 13.3, p = 0.034) and a smaller change in white blood cell count (−630 ± 959 /μL vs. 4500 ± 1190 /μL, p = 0.002) after 2 days of treatment than patients treated without PMX-DHP. The 12-month survival rate was significantly higher in patients treated with PMX-DHP (48.2% vs. 5.9%, p = 0.041). PMX-DHP was effective in patients with more severe underlying disease (GAP stages II or III; 12-month survival rate 57.1% with PMX-DHP vs. 0% without PMX-DHP, p = 0.021). Treatment with PMX-DHP was an independent predictor of better prognosis (hazard ratio 0.345, p = 0.037). Mild pulmonary thromboembolism occurred in one patient treated with PMX-DHP. CONCLUSIONS: Treatment of AE-IPF with PMX-DHP is tolerable and improves 12-month survival. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12890-015-0004-4) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4349669 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-43496692015-03-05 Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival Enomoto, Noriyuki Mikamo, Masashi Oyama, Yoshiyuki Kono, Masato Hashimoto, Dai Fujisawa, Tomoyuki Inui, Naoki Nakamura, Yutaro Yasuda, Hideo Kato, Akihiko Mimuro, Soichiro Doi, Matsuyuki Sato, Shigehito Suda, Takafumi BMC Pulm Med Research Article BACKGROUND: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis and there is currently no effective treatment for this condition. Direct hemoperfusion with a polymyxin B-immobilized fiber column (PMX-DHP) improves oxygenation, but it is unclear whether treatment of AE-IPF with PMX-DHP affects survival. This study elucidated the effectiveness and safety of PMX-DHP for the treatment of AE-IPF. METHODS: This study included 31 patients with 41 episodes of AE-IPF. All patients received steroids. Of 31, 14 patients (20 episodes) were treated with PMX-DHP. The laboratory and physiological test results after the start of therapy and survival were retrospectively compared between patients treated with and without PMX-DHP. RESULTS: Patients treated with PMX-DHP had a significantly greater change in PaO(2)/FiO(2) ratio (mean ± SEM, 58.2 ± 22.5 vs. 0.7 ± 13.3, p = 0.034) and a smaller change in white blood cell count (−630 ± 959 /μL vs. 4500 ± 1190 /μL, p = 0.002) after 2 days of treatment than patients treated without PMX-DHP. The 12-month survival rate was significantly higher in patients treated with PMX-DHP (48.2% vs. 5.9%, p = 0.041). PMX-DHP was effective in patients with more severe underlying disease (GAP stages II or III; 12-month survival rate 57.1% with PMX-DHP vs. 0% without PMX-DHP, p = 0.021). Treatment with PMX-DHP was an independent predictor of better prognosis (hazard ratio 0.345, p = 0.037). Mild pulmonary thromboembolism occurred in one patient treated with PMX-DHP. CONCLUSIONS: Treatment of AE-IPF with PMX-DHP is tolerable and improves 12-month survival. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12890-015-0004-4) contains supplementary material, which is available to authorized users. BioMed Central 2015-02-22 /pmc/articles/PMC4349669/ /pubmed/25887940 http://dx.doi.org/10.1186/s12890-015-0004-4 Text en © Enomoto et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Enomoto, Noriyuki Mikamo, Masashi Oyama, Yoshiyuki Kono, Masato Hashimoto, Dai Fujisawa, Tomoyuki Inui, Naoki Nakamura, Yutaro Yasuda, Hideo Kato, Akihiko Mimuro, Soichiro Doi, Matsuyuki Sato, Shigehito Suda, Takafumi Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival |
title | Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival |
title_full | Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival |
title_fullStr | Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival |
title_full_unstemmed | Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival |
title_short | Treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin B-immobilized fiber column improves survival |
title_sort | treatment of acute exacerbation of idiopathic pulmonary fibrosis with direct hemoperfusion using a polymyxin b-immobilized fiber column improves survival |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349669/ https://www.ncbi.nlm.nih.gov/pubmed/25887940 http://dx.doi.org/10.1186/s12890-015-0004-4 |
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