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Short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis

BACKGROUND AND OBJECTIVE: A proportion of patients with fibrotic hypersensitivity pneumonitis (fHP) follow a progressive disease course despite immunosuppressive treatment. Little is known about predictors of mortality in fHP. We aimed to investigate the impact of short‐term lung function changes in...

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Autores principales: Macaluso, Claudio, Boccabella, Cristina, Kokosi, Maria, Sivarasan, Nishanth, Kouranos, Vasilis, George, Peter M., Margaritopoulos, George, Molyneaux, Philip L., Chua, Felix, Maher, Toby M., Jenkins, Gisli R., Nicholson, Andrew G., Desai, Sujal R., Devaraj, Anand, Wells, Athol U., Renzoni, Elisabetta A., Stock, Carmel J. W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302621/
https://www.ncbi.nlm.nih.gov/pubmed/35023231
http://dx.doi.org/10.1111/resp.14204
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author Macaluso, Claudio
Boccabella, Cristina
Kokosi, Maria
Sivarasan, Nishanth
Kouranos, Vasilis
George, Peter M.
Margaritopoulos, George
Molyneaux, Philip L.
Chua, Felix
Maher, Toby M.
Jenkins, Gisli R.
Nicholson, Andrew G.
Desai, Sujal R.
Devaraj, Anand
Wells, Athol U.
Renzoni, Elisabetta A.
Stock, Carmel J. W.
author_facet Macaluso, Claudio
Boccabella, Cristina
Kokosi, Maria
Sivarasan, Nishanth
Kouranos, Vasilis
George, Peter M.
Margaritopoulos, George
Molyneaux, Philip L.
Chua, Felix
Maher, Toby M.
Jenkins, Gisli R.
Nicholson, Andrew G.
Desai, Sujal R.
Devaraj, Anand
Wells, Athol U.
Renzoni, Elisabetta A.
Stock, Carmel J. W.
author_sort Macaluso, Claudio
collection PubMed
description BACKGROUND AND OBJECTIVE: A proportion of patients with fibrotic hypersensitivity pneumonitis (fHP) follow a progressive disease course despite immunosuppressive treatment. Little is known about predictors of mortality in fHP. We aimed to investigate the impact of short‐term lung function changes in fHP on mortality. METHODS: Baseline demographics for 145 consecutive patients with a multi‐disciplinary team diagnosis of fHP, as well as baseline and 1‐year follow‐up of lung function, baseline echocardiographic findings, bronchoalveolar lavage (BAL) cellularity and all‐cause mortality were recorded. Changes in forced vital capacity (FVC) ≥ 5% and ≥10%, and diffusion capacity of the lung for carbon monoxide (DLCO) ≥ 10% and ≥15% at 1 year were calculated. Cox proportional hazards analysis was performed to test for associations with mortality. RESULTS: Baseline lung function severity, age, presence of honeycombing on computed tomography (CT) and echocardiographic pulmonary arterial systolic pressure (PASP) ≥ 40 mm Hg were associated with early mortality, while BAL lymphocytosis was associated with improved survival. A decline in FVC ≥ 5% (hazard ratio [HR]: 3.10, 95% CI: 2.00–4.81, p < 0.001), FVC ≥ 10% (HR: 3.11, 95% CI: 1.94–4.99, p < 0.001), DLCO ≥ 10% (HR: 2.80, 95% CI: 1.78–4.42, p < 0.001) and DLCO ≥ 15% (HR: 2.92, 95% CI: 1.18–4.72, p < 0.001) at 1 year was associated with markedly reduced survival on univariable and multivariable analyses after correcting for demographic variables, disease severity, honeycombing on CT and treatment, as well as BAL lymphocytosis and PASP ≥ 40 mm Hg on echocardiography, in separate models. CONCLUSION: Worsening in FVC and DLCO at 1 year, including a marginal decline in FVC ≥ 5% and DLCO ≥ 10%, is predictive of markedly reduced survival in fHP.
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spelling pubmed-93026212022-07-22 Short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis Macaluso, Claudio Boccabella, Cristina Kokosi, Maria Sivarasan, Nishanth Kouranos, Vasilis George, Peter M. Margaritopoulos, George Molyneaux, Philip L. Chua, Felix Maher, Toby M. Jenkins, Gisli R. Nicholson, Andrew G. Desai, Sujal R. Devaraj, Anand Wells, Athol U. Renzoni, Elisabetta A. Stock, Carmel J. W. Respirology ORIGINAL ARTICLES BACKGROUND AND OBJECTIVE: A proportion of patients with fibrotic hypersensitivity pneumonitis (fHP) follow a progressive disease course despite immunosuppressive treatment. Little is known about predictors of mortality in fHP. We aimed to investigate the impact of short‐term lung function changes in fHP on mortality. METHODS: Baseline demographics for 145 consecutive patients with a multi‐disciplinary team diagnosis of fHP, as well as baseline and 1‐year follow‐up of lung function, baseline echocardiographic findings, bronchoalveolar lavage (BAL) cellularity and all‐cause mortality were recorded. Changes in forced vital capacity (FVC) ≥ 5% and ≥10%, and diffusion capacity of the lung for carbon monoxide (DLCO) ≥ 10% and ≥15% at 1 year were calculated. Cox proportional hazards analysis was performed to test for associations with mortality. RESULTS: Baseline lung function severity, age, presence of honeycombing on computed tomography (CT) and echocardiographic pulmonary arterial systolic pressure (PASP) ≥ 40 mm Hg were associated with early mortality, while BAL lymphocytosis was associated with improved survival. A decline in FVC ≥ 5% (hazard ratio [HR]: 3.10, 95% CI: 2.00–4.81, p < 0.001), FVC ≥ 10% (HR: 3.11, 95% CI: 1.94–4.99, p < 0.001), DLCO ≥ 10% (HR: 2.80, 95% CI: 1.78–4.42, p < 0.001) and DLCO ≥ 15% (HR: 2.92, 95% CI: 1.18–4.72, p < 0.001) at 1 year was associated with markedly reduced survival on univariable and multivariable analyses after correcting for demographic variables, disease severity, honeycombing on CT and treatment, as well as BAL lymphocytosis and PASP ≥ 40 mm Hg on echocardiography, in separate models. CONCLUSION: Worsening in FVC and DLCO at 1 year, including a marginal decline in FVC ≥ 5% and DLCO ≥ 10%, is predictive of markedly reduced survival in fHP. John Wiley & Sons, Ltd 2022-01-12 2022-03 /pmc/articles/PMC9302621/ /pubmed/35023231 http://dx.doi.org/10.1111/resp.14204 Text en © 2022 The Authors. Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle ORIGINAL ARTICLES
Macaluso, Claudio
Boccabella, Cristina
Kokosi, Maria
Sivarasan, Nishanth
Kouranos, Vasilis
George, Peter M.
Margaritopoulos, George
Molyneaux, Philip L.
Chua, Felix
Maher, Toby M.
Jenkins, Gisli R.
Nicholson, Andrew G.
Desai, Sujal R.
Devaraj, Anand
Wells, Athol U.
Renzoni, Elisabetta A.
Stock, Carmel J. W.
Short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis
title Short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis
title_full Short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis
title_fullStr Short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis
title_full_unstemmed Short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis
title_short Short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis
title_sort short‐term lung function changes predict mortality in patients with fibrotic hypersensitivity pneumonitis
topic ORIGINAL ARTICLES
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9302621/
https://www.ncbi.nlm.nih.gov/pubmed/35023231
http://dx.doi.org/10.1111/resp.14204
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