In combined pulmonary fibrosis and emphysema (CPFE), no significant differences were found between UIP and NSIP fibrosis patterns in demographic or smoking variables, but more than half of CPFE patients had elevated systolic pulmonary artery pressure, and those with pulmonary hypertension had significantly higher age, comorbidity index, urea levels, and lower hemoglobin, hematocrit, and DLCO levels.
Key Findings
Results
No significant differences were found between UIP and NSIP pattern groups in CPFE patients across key demographic and clinical variables.
CPFE patients were divided into UIP pattern (n = 48) and NSIP pattern (n = 46) based on HRCT images.
No significant differences were found between the groups in terms of age, gender, smoking history, Charlson Comorbidity Index (CCI) score, and high-risk occupational history.
Study was conducted at Department of Radiology, Tokat Gaziosmanpasa University, Tokat, Turkiye, from January 2023 to January 2025.
Categorical data were compared using chi-square test and numerical data by Student's t-test.
Results
More than half of patients with CPFE had elevated systolic pulmonary artery pressure (sPAP), indicating pulmonary hypertension is common in this condition.
Pulmonary hypertension was defined as sPAP ≥25 mmHg as measured by echocardiography.
The paper states that 'more than half of patients with CPFE had elevated sPAP.'
The finding prompted the authors to recommend that pulmonary hypertension should be considered when evaluating CPFE patients.
Results
CPFE patients with sPAP ≥25 mmHg had significantly higher mean age and Charlson Comorbidity Index scores compared to those with lower sPAP.
Mean age was significantly higher in the group with sPAP ≥25 mmHg.
CCI score was significantly higher in the group with sPAP ≥25 mmHg.
These findings were identified when examining the relationship between pulmonary hypertension and demographic data in CPFE patients.
Results
CPFE patients with sPAP ≥25 mmHg had significantly lower hemoglobin and hematocrit levels and significantly higher urea levels.
Hemoglobin levels were significantly lower in patients with sPAP ≥25 mmHg.
Hematocrit levels were significantly lower in patients with sPAP ≥25 mmHg.
Urea levels were significantly higher in patients with sPAP ≥25 mmHg.
These laboratory differences were identified through comparison between the pulmonary hypertension and non-pulmonary hypertension groups within the CPFE cohort.
Results
Diffusing capacity of the lungs for carbon monoxide (DLCO) was significantly lower in CPFE patients with sPAP ≥25 mmHg.
DLCO levels were significantly lower in the group with sPAP ≥25 mmHg compared to those with lower sPAP.
This finding links reduced gas transfer capacity with the presence of pulmonary hypertension in CPFE patients.
DLCO was one of the pulmonary function parameters examined in relation to elevated pulmonary artery pressure.
Results
Comorbidities were significantly higher in the UIP pattern group compared to the NSIP pattern group, despite similar CCI scores between the two groups.
Comorbidities were found to be significantly higher in the UIP pattern (n = 48) compared to the NSIP pattern (n = 46).
Despite this difference in comorbidities, the overall CCI score was similar between the two fibrosis pattern groups.
This discrepancy suggests that individual comorbidity burden and its weighted composite score (CCI) may capture different aspects of disease in this population.
What This Means
This research examines a relatively newly recognized lung condition called combined pulmonary fibrosis and emphysema (CPFE), in which patients have both scarring (fibrosis) and air-trapping (emphysema) in their lungs. The study looked at 94 patients and compared two different patterns of lung scarring visible on CT scans — usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP) — to see if they differed in terms of patient age, sex, smoking history, or other health factors. The key finding was that these two scarring patterns were surprisingly similar across nearly all demographic and clinical measures, suggesting that factors like smoking and age alone do not clearly predict which type of fibrosis a CPFE patient will develop.
The study also found that more than half of all CPFE patients had elevated pressure in the arteries of their lungs — a condition called pulmonary hypertension. Patients with elevated pulmonary artery pressure tended to be older, had more health problems overall, had lower levels of hemoglobin and hematocrit (markers related to blood's oxygen-carrying capacity), higher urea levels (a marker of kidney function), and a reduced ability to transfer oxygen from the lungs into the blood (measured by a test called DLCO). These findings paint a picture of pulmonary hypertension as a serious and common complication in CPFE patients.
This research suggests that clinicians evaluating patients with CPFE should routinely assess for pulmonary hypertension using echocardiography, given how frequently it was present in this patient group. The fact that the two fibrosis patterns (UIP and NSIP) did not differ substantially on clinical or demographic grounds may have implications for how patients are classified and monitored, though further larger studies would be needed to confirm these findings and explore their clinical consequences.
Kiziloglu H, Yakar H. (2026). Combined Pulmonary Fibrosis and Emphysema: Clinicoradiological Parameters Associated with Fibrosis Patterns.. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. https://doi.org/10.29271/jcpsp.2026.09.1120