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Background <p>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.</p> Methods <p>In this prospective cohort study, 97 ARDS patients were consecutively recruited and assigned to Pirfenidone (<i>n</i> = 29), Glucocorticoid (<i>n</i> = 38), or Control (<i>n</i> = 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&#xa0;months included chest CT fibrosis score, pulmonary function [forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO)], SpO<sub>2</sub>/FiO<sub>2</sub> ratio, modified Medical Research Council (mMRC) dyspnea score, and Activities of Daily Living (ADL) score. Safety was assessed via adverse events and laboratory parameters.</p> Results <p>At 6&#xa0;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), <i>p</i> &lt; 0.05], which was comparable to that of the Control Group. FVC, SpO<sub>2</sub>/FiO<sub>2</sub>, and ADL scores at 3 and 6&#xa0;months were significantly higher in the Pirfenidone Group compared with both Glucocorticoid and Control groups (all <i>p</i> &lt; 0.01). Long-term outcomes improved relative to baseline (<i>p</i> &lt; 0.05). Short-term outcomes, mMRC scores, and safety indicators showed no significant differences among groups (<i>p</i> &gt; 0.05). No severe drug-related adverse events were observed.</p> Conclusion <p>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.</p>

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Effect of pirfenidone on the short- and long-term outcomes in pulmonary infection-related acute respiratory distress syndrome: a prospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月5日

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  • Meiling Long,
  • Yi Zhang,
  • Jin Tong

摘要

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.