The significance of periostin in the diagnosis of idiopathic pulmonary fibrosis and prediction of acute exacerbations.

BACKGROUND

This study aims to elucidate the capability of periostin (POSTN) as a serum biomarker in diagnosing idiopathic pulmonary fibrosis (IPF), assessing disease severity, and predicting acute exacerbations of IPF (AE-IPF), and to compare it with traditional IPF serum biomarkers Krebs von den Lungen-6 (KL-6), surfactant protein A (SP-A), and surfactant protein D (SP-D).

METHODS

From October 2022 to October 2023, 55 patients who were diagnosed with IPF and treated at the Third Affiliated Hospital of Anhui Medical University were enrolled in the IPF group. Additionally, 30 patients with bacterial pneumonia (BP) and 30 healthy individuals were selected as the BP and healthy control (HC) groups, respectively. All participants underwent pulmonary function tests, and enzyme-linked immunosorbent assay (ELISA) was used to measure serum POSTN, KL-6, SP-A, and SP-D levels. IPF patients also underwent high-resolution computed tomography (HRCT) to quantify HRCT scores. Receiver operating characteristic (ROC) curves were plotted to obtain sensitivity and specificity. Binary logistic regression analysis was conducted to identify AE-IPF risk factors.

RESULTS

Serum POSTN, KL-6, SP-A, and SP-D concentrations were significantly greater in the IPF group than in the BP and HC groups (P<0.001), whereas serum SP-A and SP-D levels were greater in the BP group than in the HC group (P=0.001, P=0.04). The sensitivity of POSTN for diagnosing IPF is 94.5%, and the specificity is 93.3%, both of which are higher than those of KL-6, SP-A, and SP-D. Within the IPF group, serum POSTN levels were negatively correlated with the percentage of predicted forced expiratory volume in one second (FEV1%pred) (P=0.01) and the percentage of the predicted diffusing capacity for carbon monoxide (DLCO%pred) (P=0.003). Additionally, in IPF patients, serum POSTN, KL-6, and SP-A levels were significantly positively associated with HRCT scores. Logistic regression analysis indicated that decreased DLCO%pred and increased baseline serum KL-6 levels were both independent risk factors for AE-IPF.

CONCLUSIONS

POSTN is a valuable serum biomarker for IPF and has the highest sensitivity and specificity among the four serum markers, with a diagnostic performance superior to that of KL-6, SP-A, and SP-D. DLCO%pred and KL-6 have high predictive value for AE-IPF.