Early decrease in erector spinae muscle area and future risk of mortality in idiopathic pulmonary fibrosis

Computed tomography (CT) assessment of the cross-sectional area of the erector spinae muscles (ESM(CSA)) can be used to evaluate sarcopenia and cachexia in patients with lung diseases. This study aimed to confirm whether serial changes in ESM(CSA) are associated with survival in patients with idiopathic pulmonary fibrosis (IPF). Data from consecutive patients with IPF who were referred to a single centre were retrospectively reviewed. We measured the ESM(CSA) at the level of the 12th thoracic vertebra on CT images at referral and 6 months later (n = 119). The follow-up time was from 817–1633 days (median, 1335 days) and 59 patients (49.6%) died. A univariate Cox regression analysis showed that the decline in % predicted forced vital capacity (FVC) (Hazard ratios [HR] 1.041, 95% confidence interval [CI] 1.013–1.069, P = 0.004), the decline in body mass index (BMI) (HR 1.084, 95% CI 1.037–1.128; P < 0.001) and that in ESM(CSA) (HR 1.057, 95% CI 1.027–1.086; P < 0.001) were prognostic factors. For multivariate analyses, the decline in ESM(CSA) (HR 1.039, 95% CI 1.007–1.071, P = 0.015) was a significant prognostic factor, while those in % FVC and BMI were discarded. Early decrease in ESM(CSA) may be a useful predictor of prognosis in patients with IPF.