İdiopatik Pulmoner Fibroziste Sistemik İnflamasyon Temelli Biyobelirteçler ile Mortalite Riskinin Belirlenmesi

Öz

İdiopatik pulmoner fibrozis (İPF), ilerleyici seyirli ve yüksek mortalite ile karakterize bir interstisyel akciğer hastalığıdır. Antifibrotik tedavilerin kullanılmasına rağmen hastalığın gidişatı öngörülemez olup, güvenilir prognostik biyobelirteçlere ihtiyaç devam etmektedir. Sistemik inflamasyon temelli biyobelirteçler C-reaktif protein / albümin oranı, sistemik immün-inflamasyon indeksi, sistemik inflamasyon yanıt indeksi, sistemik inflamasyon agregat indeksi (CAR, SII, SIRI, SIAI) çeşitli kronik hastalıklarda prognostik değer göstermiş olsa da antifibrotik tedavi altındaki İPF hastalarında kanıtlar sınırlıdır. Bu retrospektif, tek merkezli kohort çalışmasına 2015–2025 yılları arasında antifibrotik tedavi alan, tanısı uluslararası kriterlere göre doğrulanmış 108 İPF hastası dahil edildi. Demografik veriler, komorbiditeler, solunum fonksiyon testleri, laboratuvar ölçümleri ve tedavi detayları elektronik kayıtlardan elde edildi. CAR, SII, SIRI ve SIAI standart formüllerle hesaplandı. Üç yıllık mortalite için univaryant ve multivaryant Cox regresyon analizleri gerçekleştirildi. Çalışmaya dahil edilen hastaların yaş ortalaması 66,09±8,26 yıl olup 24,1%’i kadındı. Bazal inflamasyon belirteçleri ve sistemik inflamasyon skorları sağ kalanlar ile yaşamını kaybedenler arasında anlamlı farklılık göstermedi. Univaryant analizde eks-sigara içiciliği, paket-yıl ve KOAH varlığı mortalite ile ilişkili bulundu. Pirfenidon kullanımının koruyucu etkisi gözlense de multivaryant analizde anlamlılık kayboldu. Multivaryant modelde yalnızca prokalsitonin, mortalitenin bağımsız belirleyicisi olarak saptandı (HR=0,094; p=0,03). Antifibrotik tedavi alan İPF hastalarında CAR, SII, SIRI ve SIAI gibi yaygın inflamasyon temelli biyobelirteçlerin uzun dönem mortaliteyi öngörmede sınırlı yarar sağladığı gösterilmiştir. Prokalsitonin ise bağımsız bir prognostik belirteç olarak öne çıkmıştır. Bulgular, tedavi altındaki İPF hastalarında daha spesifik biyobelirteçlere ihtiyaç olduğunu göstermektedir.

Anahtar Kelimeler

• İdiopatik pulmoner fibrozis;
• Antifibrotik tedavi;
• Sistemik inflamasyon biyobelirteçleri

Mortality Prediction Using Systemic Inflammation Based Biomarkers in Idiopathic Pulmonary Fibrosis

Öz

Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease with poor survival despite the availability of antifibrotic therapies. Disease progression is heterogeneous, and the need for reliable prognostic biomarkers remains unmet. Systemic inflammation–based indices including C-reactive protein to albumin ratio, systemic ımmune-ınflammation ındex, systemic ınflammation response ındex, systemic ınflammation aggregate ındex (CAR, SII, SIRI, SIAI) have demonstrated prognostic value in various chronic diseases, yet evidence in IPF patients receiving antifibrotic therapy is limited. This retrospective single-center cohort study included 108 patients diagnosed with IPF according to international criteria and treated with antifibrotic agents between 2015 and 2025. Demographic characteristics, comorbidities, pulmonary function tests, laboratory measurements, and treatment details were extracted from electronic medical records. CAR, SII, SIRI, and SIAI were calculated using standard formulas. Univariable and multivariable Cox regression analyses were performed to evaluate predictors of three-year mortality. The mean age was 66.09±8.26 years, and 24.1% of patients were female. Baseline systemic inflammation markers and inflammation-based indices (CAR, SII, SIRI, SIAI) did not significantly differ between survivors and non-survivors. In univariable analysis, ex-smoking status, smoking pack-years, and COPD were significantly associated with mortality. Although pirfenidone demonstrated a protective trend, it did not retain significance after adjustment. Procalcitonin was the only independent predictor of three-year mortality in the multivariable model (HR=0.094; p=0.03). Other inflammation-based indices showed no prognostic value. In patients with IPF undergoing antifibrotic therapy, CAR, SII, SIRI, and SIAI did not predict long-term mortality, indicating limited prognostic utility of these inflammation-based biomarkers. Procalcitonin emerged as the only independent predictor. These findings highlight the need for more disease-specific and treatment-relevant biomarkers to improve prognostic stratification in IPF.

Anahtar Kelimeler

• Idiopathic pulmonary fibrosis;
• Antifibrotic therapy;
• Systemic inflammation biomarkers

Kaynakça

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