Quantitative computed tomography measures of skeletal muscle mass in patients with idiopathic pulmonary fibrosis according to a multidisciplinary discussion diagnosis: A retrospective nationwide study in Japan

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; Takehiro Izumo

doi:10.1016/j.resinv.2019.11.002

Quantitative computed tomography measures of skeletal muscle mass in patients with idiopathic pulmonary fibrosis according to a multidisciplinary discussion diagnosis: A retrospective nationwide study in Japan

Respir Investig. 2020 Mar;58(2):91-101. doi: 10.1016/j.resinv.2019.11.002. Epub 2019 Dec 24.

Authors

Affiliations

¹ Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: [email protected].
² Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: [email protected].
³ Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: [email protected].
⁴ Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: [email protected].
⁵ Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: [email protected].
⁶ Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: [email protected].
⁷ Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: [email protected].
⁸ Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8555, Japan. Electronic address: [email protected].
⁹ Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. Electronic address: [email protected].
¹⁰ Department of Radiology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, 593-8304, Japan. Electronic address: [email protected].
¹¹ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Hamadayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. Electronic address: [email protected].
¹² Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Hamadayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. Electronic address: [email protected].
¹³ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Hamadayama, Higashi-ku, Hamamatsu, Shizuoka, 431-3192, Japan. Electronic address: [email protected].
¹⁴ Department of Respiratory Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan. Electronic address: [email protected].

PMID: 31882370
DOI: 10.1016/j.resinv.2019.11.002

Abstract

Background: Idiopathic 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.

Methods: IPF patients diagnosed using MDD from April 2009 to March 2014 were included. We analyzed the cross-sectional area (CSA) of the erector spinae muscle (ESM_CSA) and the pectoralis muscle (PM_CSA), muscle attenuation of the ESM (ESM_MA), and PM (PM_MA) 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 ESM_CSA, PM_CSA, ESM_MA, PM_MA, clinical parameters, and prognosis.

Results: A 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 ESM_CSA had significantly worse survival than other groups (P = 0.009). Survival rates of the groups with the lowest quartile of PM_CSA, lower ESM_MA, and lower PM_MA did not differ from those of other groups. According to multivariate analysis, ESM_CSA < lower quartile was significantly associated with all-cause mortality (hazards ratio, 1.96; P = 0.030), whereas, ESM_MA < median, PM_CSA < lower quartile, and PM_MA < median were not.

Conclusions: Low ESM_CSA on CT images may be a strong risk factor for all-cause mortality in IPF patients based on MDD diagnosis.

Keywords: Cachexia; Idiopathic pulmonary fibrosis; Mortality; Skeletal muscle.

MeSH terms

Humans
Idiopathic Pulmonary Fibrosis / diagnostic imaging*
Idiopathic Pulmonary Fibrosis / pathology*
Interdisciplinary Communication
Japan
Muscle, Skeletal / diagnostic imaging*
Retrospective Studies
Tomography, X-Ray Computed / methods*