How does comorbidity influence survival in idiopathic pulmonary fibrosis?

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is the most common of the idiopathic interstitial pneumonias. It is a serious and progressive lung disease with a median survival of three years. The role of comorbidities in the prognosis of IPF is not clear.

OBJECTIVES: To describe comorbidity and co-medication in a Danish IPF cohort and the association between clinically important comorbidities and survival.

METHODS: The study cohort included all patients diagnosed with IPF at Aarhus University Hospital, Denmark between April 2003 and April 2009. Details on diagnostic examinations, pulmonary function, medication and comorbidities were registered based on medical records.

RESULTS: A total of 121 patients were included. The most frequently observed comorbidities were cardiovascular disease (20%), arterial hypertension (15%) and diabetes mellitus (11%). Cardiovascular disease diagnosed during follow-up significantly increased mortality (HR 4.7, 95% CI 2.0-11.1). No difference was found based on cardiovascular disease already present at the time of IPF diagnosis. Diabetes (HR 2.5, 95% CI 1.04-5.9) and anticoagulant treatment (HR 3.3, 95% CI 1.5-7.2) were also factors associated with a significantly higher mortality in this population-based cohort.

CONCLUSION: These findings emphasize the need of careful diagnosis and treatment of comorbidities and their risk factors in patients with IPF. In the absence of efficient treatment options for the majority of patients diagnosed with IPF, this may play a role in the effort to optimize the survival of IPF patients. Further studies are needed to fully clarify the impact of comorbidities on prognosis in patients diagnosed with IPF.