PMID- 36693330
OWN - NLM
STAT- MEDLINE
DCOM- 20230413
LR  - 20230419
IS  - 1423-0356 (Electronic)
IS  - 0025-7931 (Linking)
VI  - 102
IP  - 4
DP  - 2023
TI  - Patterns of Interstitial Lung Disease and Prognosis in Antineutrophil Cytoplasmic 
      Antibody-Associated Vasculitis.
PG  - 257-273
LID - 10.1159/000529085 [doi]
AB  - BACKGROUND: Interstitial lung disease (ILD) is a common pulmonary manifestation 
      of antineutrophil cytoplasmic antibody-associated vasculitis (AAV). OBJECTIVES: 
      We aimed to clarify the clinical predictors of mortality in a cohort of patients 
      with AAV-related ILD (AAV-ILD). METHOD: We retrospectively identified AAV-ILD 
      patients seen at Peking University First Hospital from January 2010 to June 2020 
      and manually screened for study inclusion. Baseline computed tomography (CT) 
      images were further classified as nonspecific interstitial pneumonia (NSIP), 
      usual interstitial pneumonia (UIP), organizing pneumonia (OP), and unclassified 
      ILD. Disease characteristics and other pulmonary findings including pulmonary 
      function test and bronchoalveolar lavage (BAL) were also evaluated. Multivariable 
      Cox regression analysis was performed to identify clinical predictors of 
      mortality. RESULTS: The cohort included 204 patients with AAV-ILD, 152 had UIP on 
      CT (AAV-UIP), 39 had NSIP on CT (AAV-NSIP), 3 had OP, and 10 had unclassified 
      ILD. Microscopic polyangiitis was more prevalent in patients with UIP, while 
      granulomatosis with polyangiitis was more common in the NSIP and OP groups, and 
      eosinophilic granulomatosis with polyangiitis was more frequent in patients with 
      unclassified ILD. ILD diagnosis before AAV was more common in patients with 
      either UIP or NSIP patterns. During the median follow-up of 40 months, 44 (21.6%) 
      patients died. One- and 5-year overall survival rates were 88.2% (95% CI, 
      83.7-92.7%) and 81.0% (95% CI, 74.9-87.1%) for the entire cohort. Patients with 
      UIP patterns had the worst prognosis, while those with NSIP patterns had the best 
      long-term outcome. Specifically, patients with UIP patterns had an approximately 
      5-fold risk of death compared to those with NSIP. After controlling for potential 
      confounding factors, we observed that each 10% increase in the BAL fluid 
      neutrophil percentage was associated with nearly a 20% increased risk of death 
      (HR 1.195, 95% CI 1.018-1.404). CONCLUSIONS: Clinical characteristics and 
      survival differ between subgroups defined by CT patterns. BAL fluid neutrophilia 
      is an independent predictor of mortality among AAV-ILD patients, and therefore, 
      the clinical utility of BAL at the time of AAV diagnosis should be considered.
CI  - (c) 2023 S. Karger AG, Basel.
FAU - Zhou, Peining
AU  - Zhou P
AD  - Department of Respiratory and Critical Care Medicine, Peking University First 
      Hospital, Beijing, China.
FAU - Li, Zhiying
AU  - Li Z
AD  - Department of Nephrology, Peking University First Hospital, Beijing, China.
FAU - Gao, Li
AU  - Gao L
AD  - Department of Radiology, Peking University First Hospital, Beijing, China.
FAU - Zhao, Bingqing
AU  - Zhao B
AD  - Department of Respiratory and Critical Care Medicine, Peking University First 
      Hospital, Beijing, China.
FAU - Que, Chengli
AU  - Que C
AD  - Department of Respiratory and Critical Care Medicine, Peking University First 
      Hospital, Beijing, China.
FAU - Li, Haichao
AU  - Li H
AD  - Department of Respiratory and Critical Care Medicine, Peking University First 
      Hospital, Beijing, China.
FAU - Ma, Jing
AU  - Ma J
AD  - Department of Respiratory and Critical Care Medicine, Peking University First 
      Hospital, Beijing, China.
FAU - Wang, Guangfa
AU  - Wang G
AD  - Department of Respiratory and Critical Care Medicine, Peking University First 
      Hospital, Beijing, China.
LA  - eng
PT  - Journal Article
DEP - 20230124
PL  - Switzerland
TA  - Respiration
JT  - Respiration; international review of thoracic diseases
JID - 0137356
RN  - 0 (Antibodies, Antineutrophil Cytoplasmic)
SB  - IM
MH  - Humans
MH  - Antibodies, Antineutrophil Cytoplasmic
MH  - Retrospective Studies
MH  - *Churg-Strauss Syndrome/complications
MH  - *Granulomatosis with Polyangiitis
MH  - *Lung Diseases, Interstitial/diagnosis
MH  - *Idiopathic Pulmonary Fibrosis/complications
MH  - *Idiopathic Interstitial Pneumonias/complications
MH  - Prognosis
OTO - NOTNLM
OT  - Antineutrophil cytoplasmic antibody-associated vasculitis
OT  - Interstitial lung disease
OT  - Mortality
EDAT- 2023/01/25 06:00
MHDA- 2023/04/13 06:42
CRDT- 2023/01/24 18:23
PHST- 2022/07/06 00:00 [received]
PHST- 2022/12/13 00:00 [accepted]
PHST- 2023/04/13 06:42 [medline]
PHST- 2023/01/25 06:00 [pubmed]
PHST- 2023/01/24 18:23 [entrez]
AID - 000529085 [pii]
AID - 10.1159/000529085 [doi]
PST - ppublish
SO  - Respiration. 2023;102(4):257-273. doi: 10.1159/000529085. Epub 2023 Jan 24.