AIM-30 Score Predicts Mortality Following Acute Exacerbation of IPF

A team of investigators has designed a new clinical scoring system they say can help predict a patient’s risk of 30-day mortality after acute exacerbation of idiopathic pulmonary fibrosis (IPF).

The scoring system could help clinicians better understand individual patient risk and potentially improve care for patients who suffer acute exacerbation. The study was published in Respirology.¹

IPF itself has a difficult prognosis, with a 3-year cumulative survival rate of 67% despite recent advances in antifibrotic therapy, noted corresponding author Jin Woo Song, MD, PhD, of the University of Ulsan College of Medicine, in South Korea, and colleagues.² Most of those patients will die from respiratory causes, and nearly half of all patients (46%) will experience acute respiratory worsening or acute exacerbation prior to death.³

The investigators said they believe their scoring system to be a useful tool that will improve patient care. | Image Credit: mi_viri

Yet, while acute exacerbation is a serious issue, Song and colleagues said the prognosis for individual patients is “relatively diverse, from complete recovery to death, highlighting the role of prognostic factors and classification systems in predicting fatal outcomes.”¹

Previous research has suggested that biomarkers like C-reactive protein and the ratio of partial arterial pressure of oxygen to the fraction of inspired oxygen may be important indicators of outcomes. But the authors said those potential biomarkers were based on studies with small sample sizes. Thus, they said, there is a need for a more robustly validated scoring system that can help clinicians better understand the risk level of particular patients who experience acute exacerbation of IPF.

The authors conducted the study at 2 South Korean tertiary hospitals, including patients who were at least 19 years old, were diagnosed with IPF, and had a confirmed case of acute exacerbation. They pulled commonly assessed clinical parameters from emergency room or hospital admission data and then used the LASSO (least absolute shrinkage and selection operator) method and multivariable logic regression to identify factors contributing to risk of 30-day mortality.

A total of 128 patients were included in the derivation cohort, and 100 patients were included in the validation cohort. In the end, the investigators found 8 variables that appeared to contribute to mortality risk. They were age 69 or above, smoking status, use of home oxygen, history of hospital admission unrelated to acute exacerbation within the past 6 months, high or low body mass index, lymphocyte percentage less than 19%, total protein less than 6.5 g/dL, and lactate level at or above 1.75 mmol/L.

The result is a 10-point scale, with most factors counting for 1 point, and current smoking status and low lymphocyte percentage each counting for 2 points. When the authors used the scale to divide patients into risk categories, they found patients with scores of 0-3 were low-risk for 30-day mortality, those with scores of 4 or 5 were at moderate risk, and patients with 6 points or above had a high risk. The authors called their scoring system the AIM-30 score, short for acute exacerbation in IPF mortality within 30 days.

Song and colleagues said one advantage of their system is that it is based on easy-to-ascertain factors. They noted that some previous attempts at risk calculation relied on CT scans, which are not only costly but also subjective.

“By implementing the AIM-30, medical staff can communicate the short-term prognosis of patients to other staff and patients/family members,” Song and colleagues wrote. “This will foster communication regarding the patient’s prognosis, facilitate proactive discussions concerning life-sustaining treatments and advanced care, and expedite necessary preparations.”

The investigators said they believe their scoring system to be a useful tool that will improve patient care, but they conceded that it was based on 2 tertiary care centers in a single metropolitan city and with patients from a single racial group. They said it is possible that cut-off scores and other measures might need to be adjusted to fit a more diverse population. For instance, they noted that the BMI measures incorporated in the AIM-30 were based on guidelines for the Asian population, and thus different cutoffs might be appropriate for different populations. Validation studies in large prospective cohorts are warranted, they said.

References

1. Kim JY, Kim J, Choi MG, et al. Development and validation of a clinical scoring system predicting 30-day mortality in acute exacerbation of idiopathic pulmonary fibrosis. Respirology. Published online July 1, 2025. doi:10.1111/resp.70071

2. Zheng Q, Cox IA, Campbell JA, et al. Mortality and survival in idiopathic pulmonary fibrosis: a systematic review and meta-analysis. ERJ Open Res. 2022;8(1):00591-2021. Published 2022 Mar 14. doi:10.1183/23120541.00591-2021

3. Collard HR, Ryerson CJ, Corte TJ, et al. Acute exacerbation of idiopathic pulmonary fiibrosis: an International Working Group report. Am J Respir Crit Care Med. 2016;194(3):265-275. doi:10.1164/rccm.201604-0801CI