ArticleTherapeutic advances in respiratory disease
Prognostic value of baseline serum KL-6 for mortality risk in patients with idiopathic pulmonary fibrosis receiving antifibrotic therapy: A retrospective cohort study.
Article in Therapeutic advances in respiratory disease. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BackgroundAntifibrotic therapy slows disease progression in idiopathic pulmonary fibrosis (IPF), but substantial prognostic heterogeneity persists among treated patients. Serum Krebs von den Lungen-6 (KL-6) is a biomarker of alveolar epithelial injury, but its prognostic value in IPF patients receiving antifibrotic therapy is not well established.ObjectivesThis study aimed to investigate factors associated with all-cause mortality during follow-up in IPF patients receiving antifibrotic therapy and to evaluate the clinical value of baseline serum KL-6 levels in prognostic assessment.DesignThis was a single-center retrospective cohort study.MethodsPatients diagnosed with IPF who received antifibrotic therapy between July 2022 and November 2024 were consecutively enrolled. Baseline clinical data and serum KL-6 levels were collected. Cox proportional hazards regression was used to identify factors associated with mortality risk, and receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off value of KL-6.ResultsA total of 126 patients with IPF receiving antifibrotic therapy were included. During a median follow-up of 21 months, 24 patients (19.0%) died. Non-survivors had significantly higher baseline KL-6 levels (P = 0.002), a higher prevalence of chronic obstructive pulmonary disease and cardiovascular disease, and lower baseline lymphocyte counts and percentage of predicted forced vital capacity (FVC% pred) compared with survivors. Multivariable Cox regression showed that cardiovascular disease (HR = 5.15, 95% CI: 1.86-14.24), lymphocyte count (HR = 0.50, 95% CI: 0.27-0.93), FVC% pred (HR = 0.98, 95% CI: 0.96-0.99), and baseline KL-6 level (per 100 U/mL increment, HR = 1.05, 95% CI: 1.02-1.07) were independently associated with all-cause mortality. ROC analysis identified an optimal KL-6 cut-off value of 746 U/mL. Patients with high KL-6 were associated with a markedly increased risk of death (HR = 7.57, 95% CI: 1.78-32.2).ConclusionsIn IPF patients receiving antifibrotic therapy, elevated baseline serum KL-6 level is independently associated with increased all-cause mortality. A cut-off value of 746 U/mL may help identify high-risk patients, and combining KL-6 with comorbidity burden, immune status, and lung function could facilitate individualized risk stratification.
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