Correlations between quantitative computed tomography metrics with serum fibrosis biomarkers, pulmonary function, and mortality risk in patients with idiopathic pulmonary fibrosis: a prospective cohort study.

BACKGROUND: In patients with idiopathic pulmonary fibrosis (IPF), accurate assessment of pulmonary function is critical for evaluating disease severity and predicting prognosis. We aimed to investigate correlations among quantitative computed tomography (CT) metrics, serum fibrosis biomarkers, and pulmonary function tests, as well as examining the association between quantitative imaging metrics and patient mortality. METHODS: A prospective cohort study was conducted between June 2018 and December 2022. Eligible patients with IPF and healthy adults underwent quantitative CT scanning. In addition, patients underwent serum fibrosis biomarker testing and pulmonary function testing and were followed up for 2 years to record mortality. RESULTS: A total of 57 patients and 30 healthy adults were included in the study. Sex distribution, age, body mass index, and smoking history were comparable between patients and healthy adults; however, patients showed a statistically significant higher percentage of high-attenuation area and mean image value but a lower total lung volume than healthy adults. Among patients, quantitative imaging measurements were significantly correlated with serum fibrosis biomarkers (hyaluronic acid, type IV collagen, laminin, and type III procollagen N-terminal peptide) and pulmonary function test results (forced vital capacity, forced expiratory volume in one second, and carbon monoxide diffusing capacity). During the 2-year follow-up period, 25 (43.9%) patients died. Cox proportional hazards regression analysis showed that age and quantitative imaging metrics were associated with patient mortality. CONCLUSIONS: Quantitative CT imaging can be used to assess disease severity, activity, and mortality risk in patients with IPF.