Assessment of malnutrition-related risk in patients with idiopathic pleuroparenchymal fibroelastosis
- Yuzo Suzuki1⇑,
- Atsuki Fukada1,
- Kazutaka Mori2,
- Masato Kono3,
- Hirotsugu Hasegawa4,
- Dai Hashimoto3,
- Koshi Yokomura4,
- Shiro Imokawa5,
- Yusuke Inoue1,
- Hideki Yasui1,
- Hironao Hozumi1,
- Masato Karayama1,
- Kazuki Furuhashi1,
- Noriyuki Enomoto1,
- Tomoyuki Fujisawa1,
- Naoki Inui1,
- Hidenori Nakamura3 and
- Takafumi Suda1
- 1Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
- 2Department of Respiratory Medicine, Shizuoka City Shimizu Hospital, Shizuoka, Japan
- 3Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
- 4Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
- 5Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
- Corresponding author: Yuzo Suzuki (yuzosuzu{at}hama-med.ac.jp)
Abstract
Background Idiopathic pleuroparenchymal fibroelastosis (iPPFE) is characterised by upper lobe-dominant fibrosis involving the pleura and subpleural lung parenchyma, with advanced cases often complicated by progressive weight loss. Therefore, we hypothesized that nutritional status is associated with mortality in iPPFE.
Methods This retrospective study assesses nutritional status at the time of diagnosis and one year after diagnosis in 131 patients with iPPFE. Malnutrition-related risk was evaluated using the Geriatric Nutritional Risk Index (GNRI).
Results Of the 131 patients, 96 (76.3%) were at malnutrition-related risk at the time of diagnosis according to GNRI. Of these, 21 patients (16.0%) were classified as at major malnutrition-related risk (GNRI <82). Patients at major malnutrition-related risk were significantly older and had worse pulmonary function than patients at low (92≤ GNRI <98)- and moderate (82≤ GNRI <92)-malnutrition-related risk. GNRI scores decreased significantly from the time of diagnosis to one year after diagnosis. Patients with lower GNRI (<91.7) had significantly shorter survival than patients with a median GNRI or higher (≥91.8). Patients with declines in annual GNRI scores of 5 or greater had significantly shorter survival than patients with declines in GNRI scores of less than 5. In multivariate analysis, major malnutrition-related risk was significantly associated with increased mortality after adjustment for age, sex and forced vital capacity (hazard-ratio, 1.957). A composite scoring model including age, sex, and major malnutrition-related risk was able to separate mortality risk in iPPFE.
Conclusion Assessment of nutritional status by GNRI provides useful information for managing patients with iPPFE by predicting mortality risk.
Footnotes
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