![]() ![]() Clinical findings, pulmonary function measures and computed tomography findings have been extensively studied to predict survival in IPF, either individually or by using composite scoring indices, however prognostication remains challenging in the individual patient due to the heterogeneity of IPF and the significant intra-patient variability of the disease behaviour. As such, accurate monitoring of disease progression in IPF is crucial for predicting prognosis and optimizing management, including the appropriate timing of supportive care and the prompt referral for lung transplantation. Despite two antifibrotic drugs, nintedanib and pirfenidone, proved to slow down the functional decline in IPF, most patients still deteriorate despite treatment. The prognosis of Idiopathic pulmonary fibrosis (IPF), the most fatal among idiopathic interstitial pneumonias, is generally poor with an estimated survival between 3 and 5 years from the time of diagnosis. ![]() Conclusionsĭiffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time. ![]() Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86–13.62, p ≤ 0.001) and significant disease progression (HR 2.99, 95% CI 1.22–7.33, p = 0.17) as compared to patients without LNE, after adjusting for GAP stage. The study population consisted of 152 IPF patients, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. The annualized rates of change in functional parameters for each patient were calculated using mixed linear models. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. This retrospective study included IPF patients referred to a single ILD centre in Italy. We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients. Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). ![]()
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