Background/Objectives: Idiopathic pulmonary fibrosis (IPF) frequently coexists with comorbidities that may influence clinical outcomes. The Charlson Comorbidity Index (CCI) quantifies the weighted comorbidity burden, whereas the age-adjusted Charlson Comorbidity Index (ACCI) additionally incorporates age. We evaluated the associations of CCI and ACCI with pulmonary function, disease severity, clinical course, and mortality in IPF. Methods: This retrospective, single-center cohort study included 319 patients with IPF. Comorbidities present at diagnosis were scored using the CCI and ACCI. Associations with pulmonary function, GAP index, acute exacerbations, hospitalization, long-term oxygen therapy, echocardiographic findings suggestive of pulmonary hypertension, incident malignancy, antifibrotic treatment, and mortality were assessed. Correlation analyses were performed using Spearman’s rank correlation coefficient, and Bonferroni correction was applied to account for multiple testing. Multivariable Cox proportional hazards regression was used to evaluate whether the CCI or ACCI was independently associated with survival. Time-to-event analyses were performed using Kaplan–Meier survival analysis. Results: The mean age was 71 ± 8 years, 78.1% were male, and 75.5% had at least one comorbid condition among patients with available comorbidity data. The median CCI and ACCI scores were 2 (IQR, 0–4) and 5 (IQR, 4–7), respectively. Higher CCI and ACCI categories were associated with hospitalization (p = 0.006 and p = 0.011), echocardiographic findings suggestive of pulmonary hypertension (both p = 0.002), and incident malignancy (p < 0.001 and p = 0.005, respectively). After Bonferroni correction, higher CCI and ACCI categories remained significantly associated with echocardiographic findings suggestive of pulmonary hypertension (both p = 0.002) and incident malignancy (both p < 0.001), whereas the associations with hospitalization did not remain statistically significant. A nominal association between ACCI and mortality (p = 0.044) also did not remain significant after Bonferroni correction. In Spearman analyses, ACCI remained significantly correlated with current age, age at IPF diagnosis, and the GAP index after correction, whereas the correlations of CCI and ACCI with baseline DLCO did not. Neither CCI (HR = 1.029, 95% CI: 0.923–1.146; p = 0.610) nor ACCI (HR = 1.035, 95% CI: 0.936–1.144; p = 0.509) was independently associated with survival in multivariable Cox regression analyses. Lower baseline DLCO remained independently associated with survival in both Cox models (both p < 0.001).Kaplan–Meier survival curves were constructed according to the predefined CCI and ACCI score categories (0, 1–2, 3–4, and ≥5), and survival distributions across categories were compared using the log-rank test. Conclusions: CCI and ACCI were associated with selected clinical characteristics in IPF, particularly echocardiographic findings suggestive of pulmonary hypertension and incident malignancy. However, neither index independently predicted survival after multivariable adjustment. These indices may complement, rather than replace, disease-specific physiological assessments in patients with IPF.

Background/Objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic interstitial lung disease with high mortality and limited treatment options. Despite recent therapeutic advances, predicting survival remains challenging. Given the challenge of predicting disease progression in IPF, identifying reliable prognostic markers may support individualized treatment strategies, guide follow-up intensity, and improve clinical decision making. This study aimed to evaluate mortality rates and factors associated with poor prognosis in patients with IPF over a 10-year period at a tertiary care center. Methods: Medical records of 268 patients diagnosed with IPF between 2015 and 2024 were retrospectively reviewed. Demographic characteristics, comorbidities, radiological findings, pulmonary function test results, frequency of exacerbations and hospitalizations, treatment details, and survival outcomes were analyzed. Univariate and multivariate logistic regression analyses were performed to identify predictors of mortality. Results: This study included 268 patients (77.2% male; median age, 72 years). During a median follow-up of 24 months, 44% (n = 118) of patients died. Deceased patients were older (p < 0.001) and had higher rates of coronary artery disease, pulmonary embolism, pulmonary hypertension, and malignancy (all p < 0.05). A definite UIP pattern was more common among deceased patients (71.2% vs. 52.4%, p = 0.02). Acute exacerbations (23.3% vs. 8.1%) and hospitalizations (61.9% vs. 23.3%) were significantly more frequent in this group (p < 0.001). In multivariate analysis, GAP score (OR 11.68, p = 0.001), pulmonary hypertension (OR 15.39, p = 0.02), history of exacerbation (OR 56.2, p = 0.04), baseline FVC (OR 1.10, p = 0.02), mean platelet volume (OR 0.29, p = 0.01), and AST level (OR 1.12, p = 0.04) were independent predictors of mortality. Conclusions: Despite advances in management, IPF continues to carry a high mortality risk. This study represents one of the largest single-center IPF cohorts from our region with long-term real-life follow-up and additionally evaluates laboratory biomarkers such as MPV and AST, which have not been widely investigated as prognostic indicators in IPF. Advanced age, reduced pulmonary function, comorbidities, and acute exacerbations are major prognostic factors. Early recognition and proactive management of these parameters may help improve survival outcomes.