Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) represents one of main worst pulmonary diseases and presents conflictive scenarios for pulmonologist and intensivists. Although a few optimal pharmacological and non-pharmacological (mechanical ventilation) treatments are available, decisions and prognosis for AE-IPF are not well standardized, and outcome predictions are difficult to make. We have read with interest the article by Kishaba T et al. who propose a predictive outcome model based on parameters of severity evaluation at immediate admission. Authors select best parameters in AE of IPF for an appropriate acute staging and mortality prediction at 3 months. Although, this study highlights recommendations for making decisions in AE, there are some aspects are controversial and were not reported previously. First, regarding the rate of in-hospital mortality (56.9 %) and the 3-month mortality rate (63.8 %), other determinants were unknown as ...