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Showing content from https://pubmed.ncbi.nlm.nih.gov/31730835/ below:

Viral Infection Increases the Risk of Idiopathic Pulmonary Fibrosis: A Meta-Analysis

Meta-Analysis

Affiliations

• ¹ Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• ² Division of Cardiology, Departments of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China.
• ³ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• ⁴ Biological Sciences, Faculty of Environmental and Life Sciences, and the Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.
• ⁵ Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• ⁶ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: huilanz_76@163.com.

• PMID: 31730835
• PMCID: PMC7214095
• DOI: 10.1016/j.chest.2019.10.032

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Meta-Analysis

Gaohong Sheng et al. Chest. 2020 May.

• ¹ Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• ² Division of Cardiology, Departments of Internal Medicine and Genetic Diagnosis Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China; Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiological Disorders, Wuhan, China.
• ³ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• ⁴ Biological Sciences, Faculty of Environmental and Life Sciences, and the Institute for Life Sciences, University of Southampton, Southampton, United Kingdom.
• ⁵ Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
• ⁶ Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: huilanz_76@163.com.

• PMID: 31730835
• PMCID: PMC7214095
• DOI: 10.1016/j.chest.2019.10.032

Item in Clipboard

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic lung disease with a poor prognosis. Although many factors have been identified that possibly trigger or aggravate IPF, such as viral infection, the exact cause of IPF remains unclear. Until now, there has been no systematic review to assess the role of viral infection in IPF quantitatively.

Objective: This meta-analysis aims to present a collective view on the relationship between viral infection and IPF.

Methods: We searched studies reporting the effect of viral infection on IPF in the PubMed, Embase, Cochrane Library, Web of Science, and Wiley Online Library databases. We calculated ORs with 95% CIs to assess the risk of virus in IPF. We also estimated statistical heterogeneity by using I² and Cochran Q tests and publication bias by using the funnel plot, Begg test, Egger test, and trim-and-fill methods. Regression, sensitivity, and subgroup analyses were performed to assess the effects of confounding factors, such as sex and age.

Results: We analyzed 20 case-control studies from 10 countries with 1,287 participants. The pooled OR of all viruses indicated that viral infection could increase the risk of IPF significantly (OR, 3.48; 95% CI, 1.61-7.52; P = .001), but not that of exacerbation of IPF (OR, 0.99; 95% CI, 0.47-2.12; P = .988). All analyzed viruses, including Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesvirus 7 (HHV-7), and human herpesvirus 8 (HHV-8), were associated with a significant elevation in the risk of IPF, except human herpesvirus 6 (HHV-6).

Conclusions: The presence of persistent or chronic, but not acute, viral infections, including EBV, CMV, HHV-7, and HHV-8, significantly increases the risk of developing IPF, but not exacerbation of IPF. These findings imply that viral infection could be a potential risk factor for IPF.

Keywords: idiopathic pulmonary fibrosis; meta-analysis; viral infection; virus.

Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.

PubMed Disclaimer

Competing interests

The authors declare that they have no competing interests.

Search flow diagram for included…

Search flow diagram for included studies in the meta-analysis.

Search flow diagram for included studies in the meta-analysis.

Forest plot shows the pooled…

Forest plot shows the pooled effect of OR for viral infection in idiopathic…

Forest plot shows the pooled effect of OR for viral infection in idiopathic pulmonary fibrosis (IPF) patients and non-IPF controls. a. Viral infection was associated with a significant increase in the risk of IPF (OR: 3.48, 95%CI: 1.61-7.52, p=0.001). b. EBV infection was associated with significantly higher risk of IPF (OR: 9.83, 95%CI: 4.22-22.91, p<0.001). c. CMV infection significantly increased the risk of IPF (OR: 2.45, 95%CI: 1.29-4.66, p=0.006). d. No significant difference was found in HHV6 infection between IPF patients and controls (OR: 3.16, 95%CI: 0.41-24.50, p=0.270). e. HHV7 infection showed significantly higher risk of IPF (OR: 2.48, 95%CI: 1.14-5.40, p=0.022). f. HHV8 infection increased the risk of IPF (OR 8.88, 95%CI: 2.70-29.14, p<0.001).

Forest plot shows the pooled…

Forest plot shows the pooled effect of OR for viral infection in idiopathic…

Forest plot shows the pooled effect of OR for viral infection in idiopathic pulmonary fibrosis (IPF) patients with acute exacerbation and with multiple viral infections compared to non-IPF controls. a. The pooled effect showed that viral infection was not associated with acute exacerbation of IPF (OR: 0.99, 95%CI: 0.46-2.12, p=0.988). b. No significant increase was found in multiple viral infections between IPF patients and controls (OR: 3.16, 95%CI: 0.41-24.50, p=0.270).

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