Service de Réanimation Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, 51 Avenue de Lattre de Tassigny, 94010, Créteil, France,
Lung. 2013 Oct;191(5):559-63. doi: 10.1007/s00408-013-9491-3. Epub 2013 Jul 19.
Initiating early steroid treatment in patients with immune diffuse alveolar hemorrhage (DAH) is a key aspect of early management. However, steroid initiation is often delayed until the results of immunological markers and/or tissue biopsy have been obtained, which could contribute to poor outcomes. We previously developed a clinical score allowing for the early diagnosis of DAH of immune causes. However, this score has not been validated in an independent cohort of patients. The aim of this study was to assess the validity of this diagnostic score using an independent cohort of patients admitted for DAH of immune and nonimmune causes.
We conducted a retrospective cohort study of patients admitted between January 2002 and December 2009 for DAH of immune and nonimmune causes.
Forty-six patients were included in the study, with 12 patients having immune DAH and 34 patients with nonimmune DAH. Application of our previously validated clinical scale of immune DAH to this independent population of patients yielded an area under the ROC curve of 0.95 [0.90-1.01]. A score ≥4/10 was associated with the best performances of this scale: sensitivity = 1.00 [0.73-1.00], specificity = 0.88 [0.72-0.97], positive predictive value = 0.75 [0.48-0.93], and negative predictive value = 1.00 [0.88-1.00].
While immunological tests and tissue biopsy results are pending, deciding whether to initiate an immunosuppressive treatment is challenging. The initiation of early corticosteroid treatment is warranted in patients with immune DAH and could improve outcomes. This study confirms that this score allows for a good discrimination between patients with immune and nonimmune DAH. Because this series has several limitations, including its single-center and retrospective nature, the small number of patients included, and the lack of therapeutic intervention, a prospective evaluation of this score is warranted to ascertain whether it can improve the adequacy of early treatment strategies and thus improve the outcomes of DAH patients.
在患有免疫性弥漫性肺泡出血（DAH）的患者中，尽早开始类固醇治疗是早期治疗的关键方面。然而，类固醇的起始通常会延迟到获得免疫标志物和/或组织活检结果后，这可能导致预后不佳。我们之前开发了一种临床评分系统，可用于早期诊断免疫性 DAH。然而，该评分尚未在独立的患者队列中得到验证。本研究的目的是使用免疫性和非免疫性 DAH 患者的独立队列评估该诊断评分的有效性。
我们对 2002 年 1 月至 2009 年 12 月期间因免疫性和非免疫性 DAH 住院的患者进行了回顾性队列研究。
研究共纳入 46 例患者，其中 12 例为免疫性 DAH，34 例为非免疫性 DAH。将我们之前验证过的免疫性 DAH 临床评分应用于该独立的患者群体，ROC 曲线下面积为 0.95 [0.90-1.01]。评分≥4/10 与该评分的最佳性能相关：敏感性=1.00 [0.73-1.00]，特异性=0.88 [0.72-0.97]，阳性预测值=0.75 [0.48-0.93]，阴性预测值=1.00 [0.88-1.00]。
在等待免疫检测和组织活检结果时，决定是否开始免疫抑制治疗具有挑战性。免疫性 DAH 患者应尽早开始皮质类固醇治疗，这可能改善预后。本研究证实，该评分可很好地区分免疫性和非免疫性 DAH 患者。由于该系列研究存在一些局限性，包括单中心和回顾性性质、纳入的患者数量较少以及缺乏治疗干预，因此需要对该评分进行前瞻性评估，以确定它是否可以改善早期治疗策略的适当性，从而改善 DAH 患者的预后。
