Significance Of Glasgow Outcome Score And Modified Glasgow Outcome Score In Predicting The Prognosis Of Patients With Acute Exacerbation Of Idiopathic Pulmonary Fibrosis

Background and ObjectiveIdiopathic pulmonary fibrosis(IPF)is a chronic parenchymal lung disease of unknown etiology.It is the most common pulmonary fibrosis disease among all idiopathic interstitial pneumonias(IIPs).Once the patient has acute exacerbation(AE),the mortality rate can be as high as 50%.Clinically,through the analysis of clinical data of patients with acute exacerbation of idiopathic pulmonary fibrosis(AE-IPF),the assessment of disease severity and possible prognosis prediction can play a certain guiding role in the treatment and management of clinical medical workers.At present,studies have reported that some serological indicators have a predictive effect on the prognosis of AE-IPF patients,but reports on the scoring system for predicting the prognosis of AE-IPF patients are rare.The Glasgow Prognostic Score(GPS)is mostly applied to the prognosis of various cancer patients.In 2018,it was first reported that GPS can be used to predict the mortality of AE-IPF patients.However,there are few reports on the prediction of the prognosis of AE-IPF patients with the modified Glasgow Outcome Score(m GPS),which is also based on systemic inflammation.GPS,m GPS scores and serological indicators can be obtained clinically in a short time,easy to operate and inexpensive.They can not only reflect the body’s systemic inflammation,but also reflect the body’s recent nutritional status,and can comprehensively assess the patient’s physical condition.The purpose of this study was to discuss the clinically easy-to-obtain serological markers and the value of GPS and m GPS scores in predicting the prognosis of AE-IPF patients,Compare the prognostic value of GPS and m GPS scores in evaluating the prognostic value of AE-IPF patients.Materials and MethodsThe clinical data of 239 patients with IPF as admission diagnosis or IPF as discharge diagnosis from July 2012 to June 2020 were collected retrospectively.In the end,a total of 61 patients with AE-IPF were included as research subjects.According to the follow-up and hospitalization data,the survival results of the patients from the time of admission to 90 days were confirmed,and the patients were divided into the surviving group(33 cases)and the dead group(28 cases).Collect the patient’s general clinical data,body temperature on the day of admission,the results of the first serological examination on admission,the results of the most recent pulmonary function test(PFT),the hospital treatment plan,and whether to stay in the intensive care unit(ICU).According to C-reactive protein(CRP)and albumin(ALB)levels,the GPS and m GPS scores of each patient were obtained.The differences in general clinical data,body temperature on the day of admission,the first serological test result of admission,the latest PFT result,the hospital treatment plan and the ICU occupancy rate of the surviving group and the dead group were compared.All patients were divided into GPS 0 points,GPS 1 point,GPS 2 points,m GPS 0 points,m GPS 1 point,and m GPS 2 groups according to GPS and m GPS scores.Compare the general clinical characteristics between different GPS and m GPS groups,the most recent PFT results,and the first serological examination results of admission.The single factor Logistic regression method was used to analyze the relationship between GPS,m GPS and serological indicators and survival status.Cox proportional hazard regression was used to analyze the effects of different scores of GPS and m GPS and serological indicators on the prognosis,and the COX regression model of GPS and m GPS was drawn to compare the differences between the two in the evaluation of survival prognosis.Results(1)According to the follow-up results within 90 days from the time of admission,there were 28 cases in the death group and 33 cases in the surviving group.There was no statistical difference between the two groups in age,gender,body mass index(BMI),smoking history,and underlying diseases(P>0.05).There was no statistically significant difference between oral steroids,N-acetylcysteine and home oxygen therapy in routine treatment outside the hospital(P>0.05).The number of oral pirfenidone treatment cases in the surviving group was more than that in the death group,and there was a statistical difference(P <0.05).(2)There were statistical differences in the levels of prealbumin(PA),ALB,total protein(TP),CRP,eosinophil absolute valueabsolute(EOS),interleukin-6(IL-6),and lactate dehydrogenase(LDH)in the two groups of hospital admission serum indexes.Among them,PA,ALB,TP,EOS in the death group were significantly lower than those in the survivor group,and the levels of CRP,IL-6,and LDH were significantly higher than those in the death group;there was no statistical difference in white blood cell count(WBC)between the two groups.There was no statistical difference in the previous PET results between the two groups(P>0.05).(3)There was no statistical difference between the two groups in the onset of dyspnea exacerbation time(P>0.05).The death group had more cases with fever than the survival group(P<0.05).Comparing the two groups of hospital treatment drugs,the death group used antibiotics combined with hormone therapy more than the survival group,and the single application of hormone therapy was less than the survival group,both of which were statistically significant(P<0.05).There was no statistical difference in the number of ICU admissions between the two groups(P>0.05).(4)The patients were divided into GPS 0,GPS 1,and GPS 2 groups according to GPS and m GPS scores,and m GPS 0,m GPS 1,and m GPS 2 groups.Comparison of general clinical characteristics,previous PFT and serological test results between different GPS scores and different m GPS score groups.The results showed that PA,ALB,TP,CRP,WBC,EOS,IL-6,LDH were statistically different between GPS and m GPS groups(P<0.05).There was no significant difference in general clinical characteristics and previous PFT results between GPS and m GPS groups(P>0.05).(5)In univariate logistic regression analysis,low serum PA,ALB level,high CRP,IL-6,LDH level,GPS1-2,m GPS1-2 scores were all risk factors for survival in AE-IPF patients(P<0.05);TP,WBC,EOS are not the risk factors for the survival of AE-IPF patients(P>0.05).(6)In the multivariate Cox proportional hazard regression analysis,low PA,high LDH level,GPS 1(HR 10.652,95%CI 2.468-45.971,P=0.002),GPS 2(HR14.655,95%CI 1.881-114.188,P=0.01),m GPS 1(HR 9.703,95%CI 2.703-34.826,P<0.001),m GPS 2(HR 8.412,95%CI 1.230-57.511,P=0.03)were associated with a significant decrease in overall survival(OS)(P<0.05).(7)The survival curve was drawn and the log-rank test was used to compare the survival rate.The survival rate of GPS0 group was higher than that of GPS1 and 2groups(P<0.001),and the survival rate of GPS1 group was higher than that of GPS2group(P=0.018).The difference was statistically significant(P <0.05).The survival rate of the m GPS0 group was higher than that of the m GPS1 and 2 groups(P<0.001),and the survival rate of the m GPS1 group was lower than that of the m GPS2 group(P=0.076),but the difference was not statistically significant(P>0.05).Conclusions(1)Serum low PA,high LDH level,GPS1-2,m GPS1-2 are independent risk factors affecting OS in patients with AE-IPF;(2)The higher the GPS score,the lower the survival rate,and it is better than the m GPS score in assessing the risk of death in patients with AE-IPF.