IPF cluster analysis highlights diagnostic delay and cardiovascular comorbidities association with outcome
- J. Bordas-Martínez1,2,5,
- R. Gavaldà3,4,
- J.G. Shull1,
- V. Vicens-Zygmunt1,
- L. Planas-Cerezales1,
- G. Bermudo-Peloche1,
- S. Santos1,2,
- N. Salord2,
- C. Monasterio2,
- M. Molina-Molina1 and
- G. Suarez-Cuartin1
- 1Interstitial Lung Disease Unit, Respiratory Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- 2Sleep Unit, Respiratory Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- 3Amalfi Analytics, Barcelona, Spain
- 4Computer Science Department, Polytechnic University of Catalonia, Barcelona, Spain
- 5First author
- Maria Molina-Molina, Chief of the ILD Unit, Respiratory Dpt, University Hospital of Bellvitge, IDIBELL, Hospitalet de Llobregat, 08907, Barcelona. E-mail: mariamolinamolina{at}hotmail.com
Abstract
Introduction Idiopathic pulmonary fibrosis (IPF) prognosis is heterogeneous despite antifibrotic treatment. Cluster analysis has proven to be a useful tool in identifying interstitial lung disease phenotypes, which has yet to be performed in IPF. The aim of this study is to identify phenotypes of IPF with different prognoses and requirements.
Methods Observational retrospective study including 136 IPF patients receiving antifibrotic treatment between 2012–2018. Six patients were excluded due to follow-up in other centers. Cluster analysis of 30 variables was performed using approximate singular value-based tensor decomposition method and comparative statistical analysis.
Results The cluster analysis identified 3 different groups of patients according to disease behavior and clinical features, including mortality, lung transplant and progression-free survival time after 3-year follow-up. Cluster 1 (n=60) was significantly associated (p=0.02) with higher mortality. Diagnostic delay was the most relevant characteristic of this cluster, as 48% of patients had ≥2 years from first respiratory symptoms to antifibrotic treatment initiation. Cluster 2 (n=22) had the longest progression-free survival time and was correlated to subclinical patients evaluated in the context of incidental findings or familial screening. Cluster 3 (n=48) showed the highest percentage of disease progression without cluster 1 mortality, with metabolic syndrome and cardiovascular comorbidities as the main characteristics.
Conclusion This cluster analysis of IPF patients suggests that diagnostic and treatment delay are the most significant factors associated with mortality, while IPF progression was more related to metabolic syndrome and cardiovascular comorbidities.
Footnotes
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Conflict of interest: Dr. Bordas-Martinez reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study.
Conflict of interest: Dr. Gavaldà reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study; .
Conflict of interest: Dr. Shull reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study; .
Conflict of interest: Dr. Vicens-Zygmunt reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study; .
Conflict of interest: Dr. Planas-Cerezales reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study; .
Conflict of interest: Dr. Bermudo-Peloche reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study; .
Conflict of interest: Dr. Santos reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study; .
Conflict of interest: Dr. Salord reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study; .
Conflict of interest: Dr. Monasterio reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study; .
Conflict of interest: Dr. Molina-Molina reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme / Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study.
Conflict of interest: Dr. Suarez-Cuartin reports grants from FIS-ISCIII: PI18/00367 (Co-funded by European Regional Development Fund, ERDF, a way to build Europe), grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 631/2018 , grants from Spanish Society of Pneumology and Thoracic Surgery (SEPAR) grant 685/2018, grants from Emerging ILD Group of SEPAR grant 005 (Boehringer-Roche), grants from Pneumology Foundation of Catalonia (FUCAP) grant 2019, grants from Spanish Sleep Society (SES) grant 2019, grants from Institutional support of CERCA Programme/Generalitat de Catalunya, grants from Research support BRN-Fundació Ramon Pla Armengol, grants from ISCIII: CM20/00093 (Co-funded by European Regional Development Fund, ESF investing in your future), during the conduct of the study.
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- Received December 2, 2020.
- Accepted March 7, 2021.
- Copyright ©The authors 2021
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