Yosuke Kamiya1, Tomoyuki Fujisawa2, Masato Kono3, Hidenori Nakamura3, Koshi Yokomura4, Naoki Koshimizu5, Mikio Toyoshima6, Shiro Imokawa7, Hiromitsu Sumikawa8, Takeshi Johkoh9, Hideki Yasui1, Hironao Hozumi1, Yuzo Suzuki1, Masato Karayama1, Kazuki Furuhashi1, Noriyuki Enomoto1, Yutaro Nakamura1, Naoki Inui10, Takafumi Suda1. 1. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, 431-3192, Japan. 2. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, 431-3192, Japan. Electronic address: fujisawa@hama-med.ac.jp. 3. Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi Naka-ku, Hamamatsu, 430-8558, Japan. 4. Department of Respiratory Medicine, Seirei Mikatahara General Hospital, 3453 Mikataharacho Kita-ku, Hamamatsu, 433-8558, Japan. 5. Department of Respiratory Medicine, Fujieda Municipal General Hospital, 4-1-11 Surugadai, Fujieda, 426-8677, Japan. 6. Department of Respiratory Medicine, Hamamatsu Rosai Hospital, 25 Shogencho Higashi-ku, Hamamatsu, 430-8525, Japan. 7. Department of Respiratory Medicine, Iwata City Hospital, 512-3 Okubocho, Iwata, 438-8550, Japan. 8. Department of Radiology, Sakai City Medical Center, 1-1-1 Ebarajicho Nishi-ku, Sakai, 593-8304, Japan. 9. Department of Radiology, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan. 10. Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu, 431-3192, Japan.
Abstract
OBJECTIVE: Interstitial lung disease (ILD) is a condition characterized by a higher mortality rate in primary Sjögren's syndrome (pSS). However, factors influencing the outcome of patients with pSS-associated ILD remain unclear. The aim of the present study was to evaluate predictive factors associated with a worse prognosis in pSS-ILD. METHODS: This retrospective study included 99 consecutive patients with pSS-ILD. Clinical characteristics, laboratory findings, and pulmonary function tests at the time of diagnosis were analyzed. Chest HRCT images were reviewed by two experienced chest radiologists. Prognostic factors were assessed by univariate and multivariate analyses, using Cox proportional hazards regression model. RESULTS: Median age was 68 years (73% women). In the total patient population, the 5- and 10-year survival rates were 89.8% and 79.0%, respectively. Univariate analysis revealed a significant association between prognosis and age, serum Krebs von den Lungen-6 (KL-6) levels, and %FVC. None of the chest HRCT findings were related to patient outcomes. Based on multivariate analyses adjusted by age and gender, lower levels of %FVC and higher levels of KL-6 were significantly associated with poor outcomes. Using optimal cutoff levels, according to receiver operating characteristic curve analyses, KL-6 > 800 U/mL were significantly associated with worse prognosis (HR: 2.91, 95% CI: 1.04-8.10). Patients with elevated serum KL-6 levels (>800 U/mL) showed a higher mortality rate than those without elevated serum KL-6 levels (p = 0.02). CONCLUSIONS: Lower %FVC and higher serum KL-6 levels are predictive factors for poor outcome in patients with pSS-ILD.
OBJECTIVE:Interstitial lung disease (ILD) is a condition characterized by a higher mortality rate in primary Sjögren's syndrome (pSS). However, factors influencing the outcome of patients with pSS-associated ILD remain unclear. The aim of the present study was to evaluate predictive factors associated with a worse prognosis in pSS-ILD. METHODS: This retrospective study included 99 consecutive patients with pSS-ILD. Clinical characteristics, laboratory findings, and pulmonary function tests at the time of diagnosis were analyzed. Chest HRCT images were reviewed by two experienced chest radiologists. Prognostic factors were assessed by univariate and multivariate analyses, using Cox proportional hazards regression model. RESULTS: Median age was 68 years (73% women). In the total patient population, the 5- and 10-year survival rates were 89.8% and 79.0%, respectively. Univariate analysis revealed a significant association between prognosis and age, serum Krebs von den Lungen-6 (KL-6) levels, and %FVC. None of the chest HRCT findings were related to patient outcomes. Based on multivariate analyses adjusted by age and gender, lower levels of %FVC and higher levels of KL-6 were significantly associated with poor outcomes. Using optimal cutoff levels, according to receiver operating characteristic curve analyses, KL-6 > 800 U/mL were significantly associated with worse prognosis (HR: 2.91, 95% CI: 1.04-8.10). Patients with elevated serum KL-6 levels (>800 U/mL) showed a higher mortality rate than those without elevated serum KL-6 levels (p = 0.02). CONCLUSIONS: Lower %FVC and higher serum KL-6 levels are predictive factors for poor outcome in patients with pSS-ILD.
Authors: Eric L Matteson; Clive Kelly; Jörg H W Distler; Anna-Maria Hoffmann-Vold; James R Seibold; Shikha Mittoo; Paul F Dellaripa; Martin Aringer; Janet Pope; Oliver Distler; Alexandra James; Rozsa Schlenker-Herceg; Susanne Stowasser; Manuel Quaresma; Kevin R Flaherty Journal: Arthritis Rheumatol Date: 2022-05-02 Impact factor: 15.483