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( Nobuyasu Awano ),( Minoru Inomata ),( Naoyuki Kuse ),( Mari Tone ),( Hanako Yoshimura ),( Tatsunori Jo ),( Kohei Takada ),( Chikatoshi Sugimoto ),( Tomonori Tanaka ),( Hiromitsu Sumikawa ),( Yuzo Su 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-
Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease often accompanied by skeletal muscle wasting. We aimed to assess whether skeletal muscle mass and muscle attenuation on computed tomography (CT) are predictors of mortality in IPF patients using a nationwide cloud-based database and web-based multidisciplinary discussion (MDD) system. Methods: IPF patients diagnosed using MDD from April 2009 to March 2014 were included. We analyzed the cross-sectional area (CSA) of the erector spinae muscle (ESM<sub>CSA</sub>) and the pectoralis muscle (PM<sub>CSA</sub>), muscle attenuation of ESM (ESM<sub>MA</sub>), and PM (PM<sub>MA</sub>) on single-slice axial CT. Survival probability was assessed by the Kaplan-Meier method and compared by the log-rank test. Multivariate Cox proportional hazards models were performed to evaluate the relationship among the ESM<sub>CSA</sub>, PM<sub>CSA</sub>, ESM<sub>MA</sub>, PM<sub>MA</sub>, clinical parameters, and prognosis. Results: A total of 199 IPF patients were enrolled. Seventy-four patients died during the study period and the most frequent cause was acute exacerbation (13.1%). The group with the lowest quartile of ESMCSA had significantly worse survival than other groups (P = 0.009). Survival rates of the groups with the lowest quartile of PM<sub>CSA</sub>, lower ESM<sub>MA</sub>, and lower PM<sub>MA</sub> were not different from other groups. After multivariate analysis, ESM<sub>CSA</sub> < lower quartile was significantly associated with all-cause mortality (hazards ratio, 1.96; P = 0.030), whereas, ESM<sub>MA</sub> < median, PM<sub>CSA</sub> < lower quartile, and PM<sub>MA</sub> < median were not. Conclusions: Low ESM<sub>CSA</sub> on CT images may be a strong risk factor for all-cause mortality in IPF patients nationwide by MDD diagnosis.