Periostin, a valuable serum biomarker in the diagnosis of idiopathic pulmonary fibrosis and prediction of acute exacerbations

Background: This study aims to elucidate the capability of periostin (POSTN) as a serum biomarker in diagnosing idiopathic pulmonary fibrosis (IPF), assessing disease severity, and predicting acute exacerbations of IPF (AE-IPF), and to compare it with traditional IPF serum biomarkers Krebs von den Lungen-6 (KL-6), surfactant protein A (SP-A), and surfactant protein D (SP-D).

Methods: From October 2022 to October 2023, 55 patients who were diagnosed with IPF and treated at the Third Affiliated Hospital of Anhui Medical University were enrolled in the IPF group. Additionally, 30 patients with bacterial pneumonia (BP) and 30 healthy individuals were selected as the BP and healthy control (HC) groups, respectively. All participants underwent pulmonary function tests, and enzyme-linked immunosorbent assay (ELISA) was used to measure serum POSTN, KL-6, SP-A, and SP-D levels. IPF patients also underwent high-resolution computed tomography (HRCT) to quantify HRCT scores. Receiver operating characteristic (ROC) curves were plotted to obtain sensitivity and specificity. Binary logistic regression analysis was conducted to identify AE-IPF risk factors.

Results: Serum POSTN, KL-6, SP-A, and SP-D concentrations were significantly greater in the IPF group than in the BP and HC groups (P<0.001), whereas serum SP-A and SP-D levels were greater in the BP group than in the HC group (P=0.001, P=0.04). The sensitivity of POSTN for diagnosing IPF is 94.5%, and the specificity is 93.3%, both of which are higher than those of KL-6, SP-A, and SP-D. Within the IPF group, serum POSTN levels were negatively correlated with the percentage of predicted forced expiratory volume in one second (FEV₁%pred) (P=0.01) and the percentage of the predicted diffusing capacity for carbon monoxide (DLCO%pred) (P=0.003). Additionally, in IPF patients, serum POSTN, KL-6, and SP-A levels were significantly positively associated with HRCT scores. Logistic regression analysis indicated that decreased DLCO%pred and increased baseline serum KL-6 levels were both independent risk factors for AE-IPF.

Conclusions: POSTN is a valuable serum biomarker for IPF and has the highest sensitivity and specificity among the four serum markers, with a diagnostic performance superior to that of KL-6, SP-A, and SP-D. DLCO%pred and KL-6 have high predictive value for AE-IPF.

Keywords: Idiopathic pulmonary fibrosis (IPF); periostin (POSTN); Krebs von den Lungen-6 (KL-6); surfactant protein A (SP-A); surfactant protein D (SP-D)

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Key findings

• Periostin (POSTN) is a valuable idiopathic pulmonary fibrosis (IPF) serum biomarker with better diagnostic performance than Krebs von den Lungen-6 (KL-6), surfactant protein A (SP-A), and surfactant protein D (SP-D). A decline in the predicted diffusing capacity for carbon monoxide (DLCO%pred) and an increase in baseline KL-6 levels are risk factors for acute exacerbation in IPF patients.

What is known and what is new?

• POSTN has emerged as a research hotspot, and playing a significant role in lung tissue remodeling and fibrosis development, thereby serving as a potential IPF biomarker.

• This study adds a comparative analysis of POSTN with KL-6, SP-A, and SP-D in diagnosing IPF. It explores the correlation of these four biomarkers with lung function, high-resolution computed tomography, and pulmonary artery systolic pressure in IPF patients, as well as their ability to predict acute exacerbations of IPF (AE-IPF).

What is the implication, and what should change now?

• POSTN outperforms KL-6, SP-A, and SP-D in diagnosing IPF, having the highest sensitivity and specificity among the four serum biomarkers. POSTN, KL-6, SP-A, and SP-D are useful for diagnosing and assessing IPF. DLCO%pred and KL-6 have high predictive value for AE-IPF.

Cite this article as: Wu S, Liu H, Yin S, Wang Y, Liu X, Ding Z. The significance of periostin in the diagnosis of idiopathic pulmonary fibrosis and prediction of acute exacerbations. J Thorac Dis 2025;17(3):1364-1376. doi: 10.21037/jtd-24-1882