Pneumologie 2018; 72(S 01): S28-S29
DOI: 10.1055/s-0037-1619192
Sektion 7 – Klinische Pneumologie
Posterbegehung – Titel: Interstitielle und granulomatöse Lungenerkrankungen I, Lungentransplantation
Georg Thieme Verlag KG Stuttgart · New York

Quality of life trajectory in patients with idiopathic pulmonary fibrosis (IPF): longitudinal QoL assessment of the INSIGHTS-IPF registry

M Kreuter
1   Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik; Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (TLRC); Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
,
J Swigris
2   Interstitial Lung Disease Program, National Jewish Health, Denver, Colorado, USA
,
D Pittrow
3   Institut für Klinische Pharmakologie, Medizinische Fakultät, Technische Universität Dresden
,
S Geier
4   Department Market Access, Boehringer Ingelheim
,
J Klotsche
5   Epidemiologie, Deutsches Rheuma-Forschungsinstitut, Berlin
,
A Prasse
6   Klinik für Pneumologie, Medizinische Hochschule, Hannover
,
H Wirtz
7   Pneumologie, Universitätsklinikum der Universität Leipzig
,
D Koschel
8   Zentrum für Pneumologie-, Thorax- und Gefäßchirurgie, Fachkrankenhaus Coswig
,
S Andreas
9   Kardiologie und Pneumologie, Lungenfachklinik Immenhausen und Universitätsmedizin Göttingen
,
C Grohe
10   Klinik für Pneumologie, ELK, Berlin Buch
,
H Wilkens
11   Pneumologie, Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
,
L Hagmeyer
12   Krankenhaus Bethanien, Solingen
,
D Skowasch
13   Medical Clinic II, University Hospital Bonn
,
FJ Meyer
14   Lungenzentrum München, LZM Bogenhausen-Harlaching, Städtisches Klinikum München GmbH
,
J Kirschner
15   Center for Internal Medical Studies Cims, Bamberg
,
S Gläser
16   Klinik und Poliklinik für Innere Medizin B, Forschungsbereich Pneumologie und Pneumologische Epidemiologie, Universitätsmedizin Greifswald; Klinik für Innere Medizin – Pneumologie, Greifswald and Vivantes Klinikum Spandau/Berlin
,
FJF Herth
17   Zentrum für Interstitielle und Seltene Lungenerkrankungen, Thoraxklinik, Uniklinikum Heidelberg
,
T Welte
18   Klinik für Pneumologie, Medizinische Hochschule Hannover
,
C Neurohr
19   Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München
,
M Schweiblmair
20   I. Medizinische Klinik, Klinikum Augsburg
,
M Held
21   Abteilung Innere Medizin, Pneumologie, Standort Missioklinik, Klinikum Würzburg Mitte
,
T Bahmer
22   Lungenclinic Großhansdorf
,
M Frankenberger
19   Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München
,
J Behr
23   Comprehensive Pneumology Center, Lungenforschungsambulanz, Klinikum der Universität München and Asklepios Fachkliniken München-Gauting; Member of the German Center for Lung Research (DZL)
› Author Affiliations
Further Information

Publication History

Publication Date:
21 February 2018 (online)

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Rationale:

Quality of life (QoL) is profoundly impaired in IPF patients; however, little is known about how their QoL changes over time. We analysed longitudinal data, gathered under real-world conditions, to improve understanding of the trajectory of QoL and its relationship to other variables in IPF patients.

Methods:

Data from 359 patients enrolled in an observational registry were included (77% male; mean values: age 68.5 ± 8.9 years, FVC% 68.1 ± 17.9, DLCO% 36.7 ± 16.8. QoL was assessed by questionnaires including the St. George's Respiratory Questionnaire (SGRQ) at enrollment and yearly thereafter. Mixed Models were used for the analyses of QoL in follow-up.

Results:

Mean follow up was 16.0 ± 9.1 months. The SGRQ significantly worsened, i.e. increased during follow-up (increase of 2.7 per year (95%CI: 1.4 – 4.0). An absolute decline in FVC% predicted ≥10% was associated with a significant deterioration in SGRQ by 13.7 (SD = 13.6), while patients with stable or improved FVC had a relevant improvement in SGRQ (mean =-5.4). Patients with a decrease of DLCO≥15% or of 6MWD≥50 m had a significant increase (i.e. deterioration) in SGRQ by 15.7 (SD = 14.5) and 8.9 (SD = 14.8) in follow-up, respectively. In multivariate analysis by a mixed model, predictors of a QoL worsening were older age, lower FVC, lower DLCO, high number of comorbid diseases and longer disease duration. Patients who died had a significant greater increase in SGRQ (mean 11.2 SD = 15) before death compared to patients who survived (mean 3.1, SD = 14.2). A similar pattern could be seen for mortality due to exacerbations (increase by 9.2 versus 4.5 for patients with and without exacerbations). If the physician judged the clinical course of IPF as a rapid progression, the patients SQRQ increased significantly in follow-up in mean by 15.1 (SD = 14.2). In contrast, patients with a judgement of stable disease reported a significantly smaller increase, i.e. less deterioration of SGRQ during follow-up (mean = 9.0, SD = 12.2).

Conclusions:

QoL assessement in the INSIGHTS-IPF registry demonstrates a close relationship between QoL and changes of pulmonary physiology, numbers of comorbidities, disease duration and clinical course of IPF including mortality.