Factors associated with rapid progression in fibrotic interstitial lung disease

Xianqiu Chen; Qiuliang Ji; Qian Yao; Ying Zhou

doi:10.1016/j.heliyon.2023.e22565

Factors associated with rapid progression in fibrotic interstitial lung disease

Heliyon. 2023 Nov 20;9(12):e22565. doi: 10.1016/j.heliyon.2023.e22565. eCollection 2023 Dec.

Authors

Xianqiu Chen¹, Qiuliang Ji¹, Qian Yao², Ying Zhou²

Affiliations

¹ Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
² Department of Respiratory Medicine and Clinical Research Center, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.

Abstract

Background: Early identification of fibrotic interstitial lung disease (F-ILD) patients with high risk of progression will help initiate early therapeutic intervention and potential improvement of outcomes. This study was designed to assess the predictors of progression in patients with F-ILD.

Methods: Patients with F-ILD in Shanghai Pulmonary Hospital between January 1, 2019 and July 31, 2021 were retrospectively analyzed. The patients enrolled were divided into progressive group and non-progressive group according to the specified criteria. Baseline characteristics were collected and a multivariate regression was conducted to identify independent predictors of progression.

Results: Of the 177 F-ILD cases, 87 were enrolled in the progressive group and 90 were in the non-progressive group. The cohort included 11 types of F-ILD, primarily were connective tissue disease-associated interstitial lung disease (CTD-ILD) (43, 24.3 %), idiopathic pulmonary fibrosis (IPF) (39, 22.0 %), interstitial pneumonia with autoimmune features (IPAF) (32, 18.1 %), and unclassifiable (23, 13.0 %). The highest proportion of progression was seen in nonspecific interstitial pneumonia (NSIP) subgroup (66.7 %), followed by IPF (59.0 %) and HP (57.1 %). After adjusting for gender and age, a course of disease longer than 9.5 months (OR: 2.633; 95 % CI: 1.190-5.826, P = 0.017), lymphocyte in peripheral blood more than 2.24 (10⁹/L) (OR: 2.670; 95 % CI: 1.095-6.510, P = 0.031), and emphysema in high-resolution computed tomography (HRCT) (OR: 2.387; 95 % CI: 1.017-5.640, P = 0.046) were independent predictors of progression in F-ILD patients.

Conclusions: This study suggested that in patients with F-ILD, long course of disease, elevated blood lymphocyte and emphysema on HRCT were independent predictors of progression, which may suggest utility in early therapeutic intervention.

Keywords: Course of disease; Emphysema; Fibrotic interstitial lung disease; Lymphocyte; Progression.