Risk Factors Fo Racute Exacerbation Of Idiopathic Pulmonary Fibrosis

Background:Acute exacerbation of Idiopathic Pulmonary Fibrosis is defined as an acute clinically significant respiratory deterioration characterized by evidence of new widespread alveolar abnormality.Studies have shown that AE-IPF has poor prognosis,high mortality rate and short survival period.Objective:To collect evidence from database and find the risk factors of AE-IPF by Meta-analysis.Method:Literature about risk factor of AE-IPF was retrieved from Cochrane Library,Pubmed,Embase and Web of Science up to December 31,2022.According to the PICOS,inclusion and exclusion criteria are formulated.Literature retrieval,screening,data extraction and quality evaluation were completed independently by two researchers.The quality of the literature is evaluated according to the Newcastle-Ottawa Quality Assessment Scale.HR and 95%CI were analyzed by either random-effects model or common-effect model.The heterogeneity between studies was evaluated by I2,the stability of conclusions was evaluated by sensitivity analysis,and publication bias was tested by funnel plots and Egger methods.Stata(MP 17)was used for data consolidation,sensitivity analysis,publication bias detection,heterogeneity evaluation and graphic production.Result:A total of 11429 articles were initially reviewed,and 21 articles were ultimately included,including data from 4719 patients and involving 28 factors.The results of the meta-analysis:FVC decline≥10%(HR=3.58,95%CI:1.82-7.03,P<0.001),mMRC≥ 2(HR=1.62,95%CI:1.38-1.9,P<0.001),and O3 exposure in high level(HR=1.46,95%CI:1.16-1.83,P=0.001)were risk factors for AE-IPF.%FVC increase 10%(HR=0.83,95%CI:0.74-0.92,P=0.001)was a protective factor for AE-IPF;Age(HR=1.01,95%CI:1-1.02,P=0.027),BMI(HR=0.98,95%CI:0.95-1.01,P=0.132),Male(HR=0.98,95%CI:0.82-1.18,P=0.852),Smoking History(HR=1.13,95%CI:0.93-1.38,P=0.224)were not associated with AE-IPF.Conclusion:1.Pulmonary function is correlated to AE-IPF.A 10%or more decrease in FVC may be a risk factor for AE-IPF and a 10%increase in%FVC may be a protective factor.2.Air pollution is associated with AE-IPF and increased O3 exposure within 6 weeks prior to onset may be a risk factor for AE-IPF.3.Dyspnea is related to AE-IPF and mMRC≥ 2 may be a risk factor for AE-IPF.4.Age,BMI,Male and smoking history may not be associated with AE-IPF.