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Comparison of clinical features between patients with acute exacerbation of idiopathic interstitial pneumonia and collagen vascular disease-associated interstitial pneumonia

Kata, Yuki Hara, Yu Murohashi, Kota Saigusa, Yusuke Nagasawa, Ryo Tagami, Yoichi Fujii, Hiroaki Aoki, Ayako Nishikawa, Yurika Tanaka, Katsushi Watanabe, Keisuke Horita, Nobuyuki Kobayashi, Nobuaki Yamamoto, Masaki Kudo, Makoto Kaneko, Takeshi 名古屋大学

2023.08

概要

Subtypes of underlying interstitial pneumonia (IP) comprise idiopathic interstitial pneumonias
(IIPs), including idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP),
and etiology-known IPs such as collagen vascular disease (CVD) and chronic hypersensitivity
pneumonia. Acute exacerbation (AE) is generally accepted to occur not only in IIPs, but also
etiology-known IPs.1-3 The prognosis of AE of IP is poor, which the histological pattern typically
involves diffuse alveolar damage superimposed upon lung fibrosis without obvious clinical causes
like fluid overload, left heart failure, or pulmonary embolism.4-8 Patients with AE of IPF have
reportedly shown in-hospital mortality rates in excess of 50%.9-11 In the retrospective cohort study
including IPF and non-IPF patients, overall survival rates for AE were 67% at 30 days, 43% at
60 days, and 40% at 90 days after admission.12 Other reports have shown mortality rates for AE
of collagen vascular disease-associated IP (CVD-IP) ranging from 34% to 83%.3,13
From the above, the prognosis of AE of IP is highly variable, and may be affected not
only by the subtype of underlying IP, but also by various background factors including age,
sex, comorbidities, and triggers of AE onset such as infection, drugs, and surgery. Especially,
evaluation of comorbidities appears important for determining the prognosis of IP. Several studies have reported significant negative impacts of arteriosclerosis, other cardiovascular diseases,
congestive heart failure, and lung cancer among patients with IPF.14,15 In previous reports, we
have proposed that the Charlson Comorbidity Index score (CCIS), which reflects the presence
and severity of comorbidities, also exerts a significant impact on treatment prognosis for AE-IP
patients.16,17 The accuracy of prediction of disease prognosis may be improved by considering
comorbidities (CCIS) among patients with subtypes of IP during AE.
This retrospective cohort study aimed to clarify prognostic factors in the AE of IP patients
and compared treatment prognosis according to the etiology of IP, including idiopathic disease
and CVD. ...

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参考文献

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Nagoya J. Med. Sci. 85. 602–611, 2023

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Comparison between AE of IIP and CVD-IP

SUPPLEMENTARY MATERIAL

Supplement Fig. Survival curves for patients with AE of IIP other than IPF and AE of IPF

The clinical characteristics including age, serum LDH, serum KL-6, PaO2/FiO2 ratio, CCIS, and HRCT scores

had no significant differences between AE of IIP other than IPF and AE of IPF and the survival curves was

also similar (P = 0.808).

AE: acute exacerbation

CCIS: Charlson Comorbidity Index score

HRCT: high-resolution computed tomography

IIP: idiopathic interstitial pneumonia

IPF: idiopathic pulmonary fibrosis

KL-6: Krebs von den Lungen-6

LDH: lactate dehydrogenase

PaO2/FiO2: partial pressure of oxygen in arterial blood/fraction of inspired oxygen

References End

Nagoya J. Med. Sci. 85. 602–611, 2023

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doi:10.18999/nagjms.85.3.602

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