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Prognostic evaluation of serum ferritin in acute exacerbation of idiopathic pulmonary fibrosis

2018; Wiley; Volume: 12; Issue: 8 Linguagem: Inglês

10.1111/crj.12918

1752-699X

Noriyuki Enomoto, Yoshiyuki Oyama, Yasunori Enomoto, Masashi Mikamo, Masato Karayama, Hironao Hozumi, Yuzo Suzuki, Masato Kono, Kazuki Furuhashi, Tomoyuki Fujisawa, Naoki Inui, Yutaro Nakamura, Takafumi Suda,

Chronic Obstructive Pulmonary Disease (COPD) Research

Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) has an extremely poor prognosis. The role of ferritin in the pathogenesis of AE-IPF is not well known while serum ferritin is a key prognostic indicator for patients with clinically amyopathic dermatomyositis with rapidly progressive interstitial pneumonia.To elucidate the clinical importance of serum ferritin in patients with AE-IPF.Thirty-seven patients (48 episodes), who were diagnosed with AE-IPF and treated at our hospital between 1997 and 2015, were retrospectively studied.Patients with AE-IPF had significantly higher levels of serum ferritin than baseline levels at the first diagnosis of IPF (P = 0.0017). Receiver operating characteristic analysis showed the cut-off value 174 ng/mL for the separation of AE (area under the curve, 0.700). No patients with AE-IPF were positive for anti- melanoma differentiation-associated gene 5 antibody. Patients with AE-IPF and higher ferritin (≥174 ng/mL) had lower %FVC and %DLCO before AE, and those with much higher ferritin (≥500 ng/mL) had significantly worse prognosis than those with lower ferritin (log-rank, P = 0.024). Immunohistochemical staining in autopsy specimens showed alveolar macrophages that were producing ferritin. Finally, in multivariate Cox proportional hazards analyses, serum ferritin level of ≥500 ng/mL was a significant worse prognostic factor (hazard ratio 5.280, P = 0.046).Higher serum ferritin may be related to a worse prognosis in patients with AE-IPF.