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Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia

BACKGROUND: Chronic eosinophilic pneumonia (CEP) is an idiopathic disorder characterised by an abnormal and marked accumulation of eosinophils in the interstitium and alveolar spaces of the lungs. Systemic corticosteroid (CS) therapy leads to marked improvement. However, relapse is common in the cli...

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Autores principales: Takeuchi, Naoko, Arai, Toru, Sasaki, Yumiko, Akira, Masanori, Matsuda, Yoshinobu, Tachibana, Kazunobu, Kasai, Takahiko, Inoue, Yoshikazu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9745510/
https://www.ncbi.nlm.nih.gov/pubmed/36524087
http://dx.doi.org/10.21037/jtd-22-511
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author Takeuchi, Naoko
Arai, Toru
Sasaki, Yumiko
Akira, Masanori
Matsuda, Yoshinobu
Tachibana, Kazunobu
Kasai, Takahiko
Inoue, Yoshikazu
author_facet Takeuchi, Naoko
Arai, Toru
Sasaki, Yumiko
Akira, Masanori
Matsuda, Yoshinobu
Tachibana, Kazunobu
Kasai, Takahiko
Inoue, Yoshikazu
author_sort Takeuchi, Naoko
collection PubMed
description BACKGROUND: Chronic eosinophilic pneumonia (CEP) is an idiopathic disorder characterised by an abnormal and marked accumulation of eosinophils in the interstitium and alveolar spaces of the lungs. Systemic corticosteroid (CS) therapy leads to marked improvement. However, relapse is common in the clinical course, and the predictive factors for relapse of CEP are not well known. This study aimed to investigate predictive factors for relapse in CS-treated cases of CEP. METHODS: We identified consecutive patients with CEP at our institution between 1999 and 2019. We retrospectively reviewed 36 CS-treated patients with CEP who underwent bronchoalveolar lavage (BAL) and high-resolution computed tomography (CT) at diagnosis. We examined relapse at least 1 year after the initiation of CS treatment. Statistical analysis included univariate and multivariate Cox proportional hazard regression analyses; P<0.05 was considered statistically significant. RESULTS: The median (interquartile range) age at diagnosis was 59.5 years (47.8–70.0 years). This study included 13 men and 23 women. Twenty-five patients (69.4%) were never smokers and 15 (41.7%) had asthma. The peripheral blood eosinophil percentage was 35.0% (15.6–55.8%), and the BAL eosinophil percentage was 40.8% (10.7–68.5%). The median serum surfactant protein-D (SP-D) level was 135 ng/mL (82.2–176.7 ng/mL). High-resolution CT revealed centrilobular opacities in 23 patients (63.9%). Relapse of CEP was observed in 20 patients (55.6%). Higher serum SP-D levels and the presence of centrilobular opacities on high-resolution CT were significant predictors of relapse in multivariate Cox proportional hazard regression analysis (P=0.017 and P=0.028, respectively). Additionally, we devised a relapse prediction model for CS-treated CEP using two categorical parameters: the presence of centrilobular opacities and serum levels of SP-D (>135/≤135 ng/mL). Based on these parameters, cases were scored 2, 1, or 0. Patients with a score of 2 experienced relapses earlier than those with scores of 1 and 0 (log-rank test; P=0.006, P=0.003, respectively). CONCLUSIONS: Centrilobular opacities on high-resolution CT and higher serum SP-D levels at diagnosis may be predictive factors for relapse in CS-treated patients with CEP.
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spelling pubmed-97455102022-12-14 Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia Takeuchi, Naoko Arai, Toru Sasaki, Yumiko Akira, Masanori Matsuda, Yoshinobu Tachibana, Kazunobu Kasai, Takahiko Inoue, Yoshikazu J Thorac Dis Original Article BACKGROUND: Chronic eosinophilic pneumonia (CEP) is an idiopathic disorder characterised by an abnormal and marked accumulation of eosinophils in the interstitium and alveolar spaces of the lungs. Systemic corticosteroid (CS) therapy leads to marked improvement. However, relapse is common in the clinical course, and the predictive factors for relapse of CEP are not well known. This study aimed to investigate predictive factors for relapse in CS-treated cases of CEP. METHODS: We identified consecutive patients with CEP at our institution between 1999 and 2019. We retrospectively reviewed 36 CS-treated patients with CEP who underwent bronchoalveolar lavage (BAL) and high-resolution computed tomography (CT) at diagnosis. We examined relapse at least 1 year after the initiation of CS treatment. Statistical analysis included univariate and multivariate Cox proportional hazard regression analyses; P<0.05 was considered statistically significant. RESULTS: The median (interquartile range) age at diagnosis was 59.5 years (47.8–70.0 years). This study included 13 men and 23 women. Twenty-five patients (69.4%) were never smokers and 15 (41.7%) had asthma. The peripheral blood eosinophil percentage was 35.0% (15.6–55.8%), and the BAL eosinophil percentage was 40.8% (10.7–68.5%). The median serum surfactant protein-D (SP-D) level was 135 ng/mL (82.2–176.7 ng/mL). High-resolution CT revealed centrilobular opacities in 23 patients (63.9%). Relapse of CEP was observed in 20 patients (55.6%). Higher serum SP-D levels and the presence of centrilobular opacities on high-resolution CT were significant predictors of relapse in multivariate Cox proportional hazard regression analysis (P=0.017 and P=0.028, respectively). Additionally, we devised a relapse prediction model for CS-treated CEP using two categorical parameters: the presence of centrilobular opacities and serum levels of SP-D (>135/≤135 ng/mL). Based on these parameters, cases were scored 2, 1, or 0. Patients with a score of 2 experienced relapses earlier than those with scores of 1 and 0 (log-rank test; P=0.006, P=0.003, respectively). CONCLUSIONS: Centrilobular opacities on high-resolution CT and higher serum SP-D levels at diagnosis may be predictive factors for relapse in CS-treated patients with CEP. AME Publishing Company 2022-11 /pmc/articles/PMC9745510/ /pubmed/36524087 http://dx.doi.org/10.21037/jtd-22-511 Text en 2022 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Takeuchi, Naoko
Arai, Toru
Sasaki, Yumiko
Akira, Masanori
Matsuda, Yoshinobu
Tachibana, Kazunobu
Kasai, Takahiko
Inoue, Yoshikazu
Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia
title Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia
title_full Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia
title_fullStr Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia
title_full_unstemmed Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia
title_short Predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia
title_sort predictive factors for relapse in corticosteroid-treated patients with chronic eosinophilic pneumonia
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9745510/
https://www.ncbi.nlm.nih.gov/pubmed/36524087
http://dx.doi.org/10.21037/jtd-22-511
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