• Nobuyasu Awano, Minoru Inomata, Naoyuki Kuse, Mari Tone, Hanako Yoshimura, Tatsunori Jo, Kohei Takada, Chikatoshi Sugimoto, Tomonori Tanaka, Hiromitsu Sumikawa, Yuzo Suzuki, Tomoyuki Fujisawa, Takafumi Suda, and Takehiro Izumo.
• Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: awanobu0606@hotmail.co.jp.
• Respir Investig. 2020 Mar 1; 58 (2): 91-101.

BackgroundIdiopathic pulmonary fibrosis (IPF) is a progressive disease often accompanied by skeletal muscle wasting. We investigated whether skeletal muscle mass and muscle attenuation on computed tomography (CT) are predictors of mortality in IPF patients, using a nationwide cloud-based database and web-based multidisciplinary discussion (MDD) system.MethodsIPF patients diagnosed using MDD from April 2009 to March 2014 were included. We analyzed the cross-sectional area (CSA) of the erector spinae muscle (ESMCSA) and the pectoralis muscle (PMCSA), muscle attenuation of the ESM (ESMMA), and PM (PMMA) on single-slice axial CT. Survival probability was assessed using the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox proportional hazards models were used to evaluate the relationship among the ESMCSA, PMCSA, ESMMA, PMMA, clinical parameters, and prognosis.ResultsA total of 199 IPF patients were enrolled. Seventy-four patients died during the study period and the most frequent cause was acute exacerbation (13.1%). The group with the lowest quartile of ESMCSA had significantly worse survival than other groups (P = 0.009). Survival rates of the groups with the lowest quartile of PMCSA, lower ESMMA, and lower PMMA did not differ from those of other groups. According to multivariate analysis, ESMCSA < lower quartile was significantly associated with all-cause mortality (hazards ratio, 1.96; P = 0.030), whereas, ESMMA < median, PMCSA < lower quartile, and PMMA < median were not.ConclusionsLow ESMCSA on CT images may be a strong risk factor for all-cause mortality in IPF patients based on MDD diagnosis.Copyright © 2019 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

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