Chest
Original ResearchDiffuse Lung DiseaseBlood Biomarkers MMP-7 and SP-A: Predictors of Outcome in Idiopathic Pulmonary Fibrosis
Section snippets
Study Population
The study subjects were 118 patients with IPF (68 of whom had biopsy-proven IPF) in the pulmonary department at Asan Medical Center in Seoul, South Korea, between September 2004 and December 2008 whose blood was collected at the time of diagnosis. Ten long-term survivors (survival > 8 years) in whom blood sampling was performed several years after diagnosis, while they were still clinically stable, were included. All subjects met the diagnostic criteria of the American Thoracic Society
Baseline Clinical Features
The mean age of the subjects was 62 years and 81% were male (Table 1). The median follow-up period was 24 months. Nonsurvivors were older with lower albumin levels and lung function, poorer exercise capacity, and higher scores of HC and total extent on HRCT compared with survivors (Table 1).
Baseline Levels of Plasma Biomarkers
Mean levels of MMP-7, KL-6, SP-A, and SP-D are shown in Table 2. MMP-7 and KL-6 levels were significantly elevated in nonsurvivors compared with survivors (Table 2).
Correlation of Baseline Levels of Plasma Biomarkers and Mortality
On univariate Cox analysis, all biomarkers
Discussion
Our study showed that plasma levels of the biomarkers MMP-7 and SP-A were useful predictors of poor disease outcomes, including mortality and disease progression (loss of lung function), in patients with IPF. The combination of two indices yielded a more accurate prediction than either index alone. However, the combination of MMP-7 and SP-A with the clinical parameters was only marginally superior to the clinical characteristics alone; the addition of KL-6 made it statistically significant,
Conclusions
Our data showed that blood levels of MMP-7 and SP-A are useful predictors of mortality and disease progression in IPF. The combination of both biomarkers yielded only marginally better prediction than clinical parameters alone, however, with addition of three biomarkers (MMP-7, SP-A and KL-6), the improvement in predictability became statistically significant. Further study with greater numbers of the patients is warranted.
Acknowledgments
Author contributions: Dr Kim had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Song: contributed to the study design, data analysis, writing of the manuscript, and served as first author.
Dr Do: contributed to data acquisition and analysis, and review and revision of the manuscript.
Dr Jang: contributed to data acquisition and analysis, and review and revision of the manuscript.
Dr Colby: contributed to
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Funding/Support: This study was supported by grant number 2010-495 from the Asan Institute for Life Sciences, Seoul, South Korea.
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