Background
Methods
Study subjects
HRCT scanning
Statistical analysis
Results
Clinical characteristics
n | All patients | AE-IPF group | AE-CTD-ILD group | p value | |
---|---|---|---|---|---|
Clinical Characteristics | |||||
Gender (M/F) | 177 | 116/61 | 81/26 | 35/35 | < 0.001 |
Age (years old) | 177 | 67.46 ± 9.72 | 68.52 ± 9.87 | 65.84 ± 9.33 | 0.073 |
Smoking history (Y/N) | 177 | 56/121 | 38/69 | 18/52 | 0.170 |
Prior corticosteroids use (Y/N) | 177 | 125/52 | 68/39 | 57/13 | 0.011 |
Prior immunosuppressant use (Y/N) | 177 | 39/138 | 3/104 | 36/34 | < 0.001 |
Prior NAC use (Y/N) | 177 | 153/24 | 91/16 | 62/8 | 0.503 |
Reduction or Discontinuation of corticosteroids before AE (Y/N) | 177 | 57/120 | 34/73 | 23/47 | 0.880 |
Fever (Y/N) | 177 | 105/72 | 62/43 | 43/29 | 0.861 |
WBC count (×109) | 177 | 11.12 ± 4.55 | 11.26 ± 4.91 | 10.91 ± 3.97 | 0.619 |
ESR (mm/h) | 177 | 39 (0–120) | 39 (0–120) | 40 (0–101) | 0.275 |
CRP (mg/L) | 177 | 50.2 (0.2–246) | 47 (0.2–243.5)) | 56.05 (0.2–246) | 0.603 |
LDH (U/L) | 177 | 439.26 ± 174.13 | 438.28 ± 158.32 | 440.76 ± 197.06 | 0.927 |
ALB (g/L) | 177 | 32.14 ± 3.48 | 32.88 ± 3.45 | 31.01 ± 3.23 | < 0.001 |
BNP (pg/ml) | 125 | 94.30 (0–1130) | 104 (5–828) | 88.15 (0–1130) | 0.869 |
PaO2/FiO2 ratio | 177 | 126 (34–357) | 121 (45–246) | 140.50 (34–357) | 0.050 |
D-dimer (mg/L) | 153 | 1.84 (0.02–24.82) | 1.46 (0.02–22.4) | 2.06 (0.10–24.82) | 0.023 |
CT Score | 177 | 8 (4–8) | 8 (4–8) | 8 (4–8) | 0.772 |
FVC (L) | 105 | 2.02 (0.74–4.61) | 2.05 (0.74–3.36) | 1.86 (0.86–4.61) | 0.886 |
FVC % pred | 105 | 63.22 ± 18.39 | 60.33 ± 17.32 | 66.18 ± 19.20 | 0.170 |
TLC% pred | 89 | 53.15 ± 12.81 | 48.80 ± 13.53 | 57.67 ± 10.45 | 0.012 |
DLCO % pred | 89 | 41.66 ± 15.59 | 38.66 ± 14.78 | 44.78 ± 16.09 | 0.163 |
PAH (mmHg) | 89 | 42 ± 9.848 | 41.97 ± 9.642 | 42.03 ± 10.222 | 0.980 |
BMI (kg/m2) | 105 | 24.44 (17.58–34.11) | 24.44 (17.99–30.53) | 24.52 (17.58–34.11) | 0.836 |
Anti-fibrotic therapy (Y/N) | 3 | 3/176 | 3/104 | 0/70 | 0.279 |
Treatments after AE | |||||
Mechanical Ventilation (MV, Y/N) | 177 | 93/84 | 57/50 | 36/34 | 0.810 |
Maximal dosage of methylprednisonle (mg/d) | 177 | 240 (40–1000) | 240 (40–1000) | 240 (40–1000) | 0.252 |
Immunosuppressant (Y/N) | 177 | 58/119 | 14/93 | 44/26 | < 0.001 |
Immunoglobulin (Y/N) | 177 | 72/105 | 43/64 | 29/41 | 0.869 |
Co-trimoxazole (Y/N) | 177 | 99/78 | 57/50 | 42/28 | 0.378 |
Caspofungin (Y/N) | 177 | 38/139 | 16/91 | 22/48 | 0.009 |
AE occurrence in patients with CTD-ILD
Clinical Variables | Univariate Cox Model | Multivariate Cox Model | ||||
---|---|---|---|---|---|---|
HR | 95.0%CI | p value | HR | 95.0% CI | p value | |
AE-IPF group | ||||||
Gender | 0.950 | 0.578–1.559 | 0.838 | – | – | – |
Age (years old) | 1.009 | 0.986–1.032 | 0.441 | – | – | – |
Smoking history | 1.347 | 0.858–2.113 | 0.195 | 0.499 | 0.103–2.407 | 0.386 |
Prior corticosteroids use | 0.802 | 0.511–1.258 | 0.336 | 0.654 | 0.087–4.909 | 0.680 |
Prior immunosuppressant use | 0.638 | 0.157–2.599 | 0.531 | – | – | – |
Corticosteroids reduction or discontinuation | 0.818 | 0.516–1.298 | 0.393 | – | – | – |
FVC (L) | 0.719 | 0.415–1.245 | 0.239 | 0.284 | 0.024–3.393 | 0.320 |
TLC% pred | 1.015 | 0.983–1.048 | 0.371 | 1.279 | 0.957–1.709 | 0.096 |
DLCO% pred | 0.984 | 0.958–1.011 | 0.244 | – | – | – |
PAH (mmHg) | 0.959 | 0.921–1.000 | 0.048 | 0.950 | 0.875–1.031 | 0.217 |
BMI (kg/m2) | 0.932 | 0.815–1.066 | 0.304 | 0.743 | 0.534–1.032 | 0.077 |
AE-CTD-fILD group | ||||||
Gender | 0.751 | 0.434–1.301 | 0.308 | – | – | – |
Age (years old) | 0.995 | 0.963–1.028 | 0.765 | – | – | – |
Smoking history | 0.654 | 0.335–1.277 | 0.214 | 2.567 | 0.076–86.493 | 0.599 |
Prior corticosteroids use | 0.415 | 0.215–0.802 | 0.009 | 0.049 | 0.002–1.487 | 0.083 |
Prrior immunosuppressant use | 0.727 | 0.421–1.253 | 0.251 | – | – | – |
Corticosteroids reduction or discontinuation | 0.702 | 0.385–1.280 | 0.248 | – | – | – |
FVC (L) | 0.857 | 0.559–1.313 | 0.478 | 3.521 | 0.306–40.477 | 0.312 |
TLC% pred | 0.964 | 0.921–1.009 | 0.117 | 0.688 | 0.505–0.938 | 0.018 |
DLCO% pred | 1.000 | 0.969–1.033 | 0.986 | – | – | – |
PAH (mmHg) | 1.026 | 0.986–1.068 | 0.209 | 1.351 | 0.974–1.873 | 0.072 |
BMI (kg/m2) | 0.935 | 0.856–1.022 | 0.137 | 0.823 | 0.666–1.016 | 0.823 |
Survival
Prognostic factors
Clinical Variables | AE-IPF group | AE-CTD-fILD group | ||
---|---|---|---|---|
r | p value | r | p value | |
WBC count (× 109) | −0.277 | 0.004 | −0.323 | 0.006 |
LDH (U/L) | −0.220 | 0.023 | −0.296 | 0.013 |
PaO2/FiO2 ratio | 0.158 | 0.104 | 0.407 | < 0.001 |
CT score | −0.433 | < 0.001 | −0.252 | 0.035 |
Maximal dosage of methylprednisolone (mg/d) | −0.196 | 0.043 | −0.146 | 0.227 |
Clinical Variables | Univariate Cox Model | Multivariate Cox Model | ||||
---|---|---|---|---|---|---|
HR | 95.0% CI | p value | HR | 95.0% CI | p value | |
WBC count (×109) | 1.075 | 1.041–1.109 | <0.001 | 1.051 | 1.013–1.090 | 0.008 |
CRP (mg/L) | 1.003 | 1.000–1.006 | 0.038 | 1.003 | 0.999–1.007 | 0.157 |
LDH (U/L) | 1.003 | 1.002–1.004 | <0.001 | 1.000 | 0.998–1.001 | 0.430 |
ALB (U/L) | 0.943 | 0.987–0.992 | 0.022 | 1.000 | 0.999–1.001 | 0.545 |
D-dimmer | 1.048 | 1.018–1.080 | 0.002 | 1.021 | 0.971–1.074 | 0.421 |
PaO2/FiO2 ratio | 0.991 | 0.998–0.994 | <0.001 | 0.991 | 0.987–0.994 | <0.001 |
CT score | 1.402 | 1.195–1.645 | <0.001 | 1.337 | 1.063–1.682 | 0.013 |
MV | 2.877 | 2.070–4.000 | <0.001 | – | – | – |
Maximal dosage of methylprednisolone (mg/d) | 1.001 | 1.000–1.001 | 0.016 | 1.000 | 0.999–1.001 | 0.840 |
Immunosuppressant | 0.673 | 0.478–0.947 | 0.023 | – | – | – |
Immunoglobulin | 2.103 | 1.524–2.901 | <0.001 | – | – | – |
Co-trimoxazole | 1.382 | 1.009–1.892 | 0.044 | – | – | – |
Caspofungin | 2.057 | 1.406–3.009 | <0.001 | – | – | – |
Clinical Variables | Univariate Cox Model | Multivariate Cox Model | ||||
---|---|---|---|---|---|---|
HR | 95.0% CI | p value | HR | 95.0% CI | p value | |
AE-IPF group | ||||||
WBC count (×109) | 1.071 | 1.033–1.111 | < 0.001 | 1.069 | 1.031–1.109 | < 0.001 |
LDH (U/L) | 1.002 | 1.001–1.003 | 0.003 | – | – | – |
PaO2/FiO2 ratio | 0.993 | 0.989–0.997 | 0.001 | 0.993 | 0.989–0.997 | 0.002 |
CT score | 1.703 | 1.343–2.158 | < 0.001 | 1.573 | 1.211–2.042 | 0.001 |
MV | 2.673 | 1.747–4.087 | < 0.001 | – | – | – |
Maximal dosage of methylprednisolone (mg/d) | 1.001 | 1.000–1.002 | 0.006 | 1.000 | 1.000–1.001 | 0.534 |
Immunoglobulin | 2.182 | 1.427–3.338 | < 0.001 | – | – | – |
Caspofungin | 1.809 | 1.038–3.153 | 0.036 | – | – | – |
AE-CTD-fILD group | ||||||
WBC count (×109) | 1.098 | 1.027–1.175 | 0.006 | 1.074 | 1.004–1.150 | 0.038 |
LDH (U/L) | 1.004 | 1.002–1.005 | < 0.001 | |||
PaO2/FiO2 ratio | 0.989 | 0.985–0.994 | < 0.001 | 0.989 | 0.984–0.994 | < 0.001 |
CT score | 1.253 | 0.993–1.582 | 0.058 | 0.975 | 0.746–1.274 | 0.852 |
MV | 3.495 | 2.020–6.047 | < 0.001 | |||
Maximal dosage of methylprednisolone (mg/d) | 1.000 | 0.999–1.001 | 0.613 | 0.999 | 0.998–1.000 | 0.277 |
Immunoglobulin | 2.370 | 1.401–4.009 | 0.001 | – | – | – |
Caspofungin | 2.741 | 1.563–4.808 | < 0.001 | – | – | – |