Effect of pirfenidone on the short- and long-term outcomes in pulmonary infection-related acute respiratory distress syndrome: a prospective cohort study.
- 1Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
- 2Department of Critical Care Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China. [email protected].
Abstract
Background
Pirfenidone, approved for idiopathic pulmonary fibrosis (IPF), slows lung function decline and reduces fibrosis, including in post-COVID-19 pulmonary fibrosis. Its early use in acute respiratory distress syndrome (ARDS) remains uncertain. This study evaluated the effects of early pirfenidone administration on short- and long-term outcomes in pulmonary infection-related ARDS.Methods
In this prospective cohort study, 97 ARDS patients were consecutively recruited and assigned to Pirfenidone (n = 29), Glucocorticoid (n = 38), or Control (n = 30) groups according to the severity and clinical course of the disease by the attending clinical team, all receiving standard care. Short-term outcomes included 28-day mortality, ICU length of stay, and hospital length of stay. Long-term outcomes at 3 and 6 months included chest CT fibrosis score, pulmonary function [forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO)], SpO₂/FiO₂ ratio, modified Medical Research Council (mMRC) dyspnea score, and Activities of Daily Living (ADL) score. Safety was assessed via adverse events and laboratory parameters.Results
At 6 months, the Pirfenidone Group had significantly lower chest CT fibrosis scores than the Glucocorticoid Group [3.0 (0.0-6.5) vs. 6.0 (4.0-8.0), p < 0.05], which was comparable to that of the Control Group. FVC, SpO₂/FiO₂, and ADL scores at 3 and 6 months were significantly higher in the Pirfenidone Group compared with both Glucocorticoid and Control groups (all p < 0.01). Long-term outcomes improved relative to baseline (p < 0.05). Short-term outcomes, mMRC scores, and safety indicators showed no significant differences among groups (p > 0.05). No severe drug-related adverse events were observed.Conclusion
Early pirfenidone administration in pulmonary infection-related ARDS enhances long-term functional recovery and reduces fibrosis without increasing safety risks, although it does not significantly impact short-term outcomes. These findings support the consideration of early antifibrotic therapy in ARDS management.
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BibTeX
@article{long2026effect,
title = {{Effect of pirfenidone on the short- and long-term outcomes in pulmonary infection-related acute respiratory distress syndrome: a prospective cohort study.}},
author = {Meiling Long and Yi Zhang and Jin Tong},
journal = {BMC pulmonary medicine},
year = {2026},
month = aug,
doi = {10.1186/s12890-026-04552-0},
url = {https://europepmc.org/article/MED/42972547},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Effect of pirfenidone on the short- and long-term outcomes in pulmonary infection-related acute respiratory distress syndrome: a prospective cohort study.
AU - Meiling Long
AU - Yi Zhang
AU - Jin Tong
PY - 2026
DA - 2026/08/05
JO - BMC pulmonary medicine
DO - 10.1186/s12890-026-04552-0
UR - https://europepmc.org/article/MED/42972547
AB - Background Pirfenidone, approved for idiopathic pulmonary fibrosis (IPF), slows lung function decline and reduces fibrosis, including in post-COVID-19 pulmonary fibrosis. Its early use in acute respiratory distress syndrome (ARDS) remains uncertain. This study evaluated the effects of early pirfenidone administration on short- and long-term outcomes in pulmonary infection-related ARDS.Methods In this prospective cohort study, 97 ARDS patients were consecutively recruited and assigned to Pirfenidone (n = 29), Glucocorticoid (n = 38), or Control (n = 30) groups according to the severity and clinical course of the disease by the attending clinical team, all receiving standard care. Short-term outcomes included 28-day mortality, ICU length of stay, and hospital length of stay. Long-term outcomes at 3 and 6 months included chest CT fibrosis score, pulmonary function [forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO)], SpO₂/FiO₂ ratio, modified Medical Research Council (mMRC) dyspnea score, and Activities of Daily Living (ADL) score. Safety was assessed via adverse events and laboratory parameters.Results At 6 months, the Pirfenidone Group had significantly lower chest CT fibrosis scores than the Glucocorticoid Group [3.0 (0.0-6.5) vs. 6.0 (4.0-8.0), p < 0.05], which was comparable to that of the Control Group. FVC, SpO₂/FiO₂, and ADL scores at 3 and 6 months were significantly higher in the Pirfenidone Group compared with both Glucocorticoid and Control groups (all p < 0.01). Long-term outcomes improved relative to baseline (p < 0.05). Short-term outcomes, mMRC scores, and safety indicators showed no significant differences among groups (p > 0.05). No severe drug-related adverse events were observed.Conclusion Early pirfenidone administration in pulmonary infection-related ARDS enhances long-term functional recovery and reduces fibrosis without increasing safety risks, although it does not significantly impact short-term outcomes. These findings support the consideration of early antifibrotic therapy in ARDS management.
SN - 1471-2466
ER -