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Combination of High-Resolution Computed Tomography Pattern and the Changes of Serum Marker Levels Can Predict Survival of Acute Exacerbation in Idiopathic Interstitial Pneumonias
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A2541 - Combination of High-Resolution Computed Tomography Pattern and the Changes of Serum Marker Levels Can Predict Survival of Acute Exacerbation in Idiopathic Interstitial Pneumonias
Author Block: T. Arai1, C. Sugimoto1, K. Tachibana1, Y. Inoue1, M. Akira1, T. Okuma2, S. Tokura1, T. Kasai1, M. Kitaichi3, S. Hayashi1, Y. Inoue1; 1NHO Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan, 2Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan, 3NHO Minami Wakayama Medical Center, Tanabe, Wakayama, Japan.
[Introduction] We have reported high-resolution computed tomography (HRCT) patterns at acute exacerbation (AE) in idiopathic pulmonary fibrosis (IPF) can predict survival (Akira, AJRCCM2008). Serum surfactant protein (SP)-D is a significant prognostic factor in AE in idiopathic interstitial pneumonias (IIPs) (Arai, Respirology2017). Utility of serum marker change before and at the onset of AE has not been evaluated. [Material and Methods] AE-IIPs diagnosed between 2004 and 2016 in our institute were 113 cases. Subjects of this study were 77 out of the 113 cases, whose serum markers {Krebs von den Lungen (KL)-6 and SP-D} were measured before and at the onset of AE. HRCT pattern was classified into diffuse/multifocal/peripheral patterns (Akira, AJRCCM2008). Prognostic significance of HRCT patterns, serum markers, and increase rate of serum marker levels and combination of these parameters was examined by Cox proportional hazard regression analysis. [Results] Subjects included IPF/Non-IPF (31/46 cases) and Male/female (60/17 cases). Serum KL-6 and SP-D at AE (median; 1690 IU/mL, 254 ng/mL, respectively) increased significantly as compared with that before AE (median; 1228 IU/mL, 182 ng/mL, respectively). Increase rate of serum markers was not a significant prognostic factor in total cases, cases with diffuse pattern and cases with peripheral pattern; however, lower increase rate of serum KL-6 levels (≤0.214) was a significant poor prognostic factor in cases with multifocal pattern. For total cases, long term oxygen therapy (LTOT) and lower PaO2/FiO2 ratio was a significant poor prognostic factor by multivariate Cox analysis with stepwise method. Although diffuse pattern was a significant poor prognostic factor by univariate analysis, it was not a significant factor after the adjustment by multivariate analysis using LTOT and PaO2/FiO2 ratio. AE-IIPs with multifocal pattern accompanying lower increase rate of serum KL-6 levels or with diffuse pattern was a significant poor prognostic factor by univariate analysis and it was also significant after the adjustment using LTOT and PaO2/FiO2 ratio. [Conclusions] Combination of HRCT patterns and increase rate of serum KL-6 levels before and at the onset of AE was useful to predict prognosis of AE-IIPs. [Financial Supports] This study was partially supported by a grant from the National Hospital Organization {H28-NHO (Kokyu)-2} awarded to T. Arai and Y. Inoue, and AMED: DLD/14526278 and PAP/14526182 awarded to Y. Inoue and Y. Inoue and T. Arai, respectively.
Author Block: T. Arai1, C. Sugimoto1, K. Tachibana1, Y. Inoue1, M. Akira1, T. Okuma2, S. Tokura1, T. Kasai1, M. Kitaichi3, S. Hayashi1, Y. Inoue1; 1NHO Kinki-Chuo Chest Medical Center, Sakai, Osaka, Japan, 2Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan, 3NHO Minami Wakayama Medical Center, Tanabe, Wakayama, Japan.
[Introduction] We have reported high-resolution computed tomography (HRCT) patterns at acute exacerbation (AE) in idiopathic pulmonary fibrosis (IPF) can predict survival (Akira, AJRCCM2008). Serum surfactant protein (SP)-D is a significant prognostic factor in AE in idiopathic interstitial pneumonias (IIPs) (Arai, Respirology2017). Utility of serum marker change before and at the onset of AE has not been evaluated. [Material and Methods] AE-IIPs diagnosed between 2004 and 2016 in our institute were 113 cases. Subjects of this study were 77 out of the 113 cases, whose serum markers {Krebs von den Lungen (KL)-6 and SP-D} were measured before and at the onset of AE. HRCT pattern was classified into diffuse/multifocal/peripheral patterns (Akira, AJRCCM2008). Prognostic significance of HRCT patterns, serum markers, and increase rate of serum marker levels and combination of these parameters was examined by Cox proportional hazard regression analysis. [Results] Subjects included IPF/Non-IPF (31/46 cases) and Male/female (60/17 cases). Serum KL-6 and SP-D at AE (median; 1690 IU/mL, 254 ng/mL, respectively) increased significantly as compared with that before AE (median; 1228 IU/mL, 182 ng/mL, respectively). Increase rate of serum markers was not a significant prognostic factor in total cases, cases with diffuse pattern and cases with peripheral pattern; however, lower increase rate of serum KL-6 levels (≤0.214) was a significant poor prognostic factor in cases with multifocal pattern. For total cases, long term oxygen therapy (LTOT) and lower PaO2/FiO2 ratio was a significant poor prognostic factor by multivariate Cox analysis with stepwise method. Although diffuse pattern was a significant poor prognostic factor by univariate analysis, it was not a significant factor after the adjustment by multivariate analysis using LTOT and PaO2/FiO2 ratio. AE-IIPs with multifocal pattern accompanying lower increase rate of serum KL-6 levels or with diffuse pattern was a significant poor prognostic factor by univariate analysis and it was also significant after the adjustment using LTOT and PaO2/FiO2 ratio. [Conclusions] Combination of HRCT patterns and increase rate of serum KL-6 levels before and at the onset of AE was useful to predict prognosis of AE-IIPs. [Financial Supports] This study was partially supported by a grant from the National Hospital Organization {H28-NHO (Kokyu)-2} awarded to T. Arai and Y. Inoue, and AMED: DLD/14526278 and PAP/14526182 awarded to Y. Inoue and Y. Inoue and T. Arai, respectively.
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