Cao Heng, Huan Caijuan, Wang Qin, Xu Guanhua, Lin Jin, Zhou Jianying
Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Rheumatol Ther. 2020 Dec;7(4):967-978. doi: 10.1007/s40744-020-00244-1. Epub 2020 Oct 26.
Risk prediction is challenging in patients with idiopathic inflammatory myopathies (IIM) and acute exacerbation of interstitial lung disease (AE-ILD) because of heterogeneity and patient-specific variables. Our objective was to assess whether mortality is accurately predicted in patients with IIM and AE-ILD by using the gender age physiology ILD (GAP-ILD) model, a clinical prediction model that was previously validated in patients with idiopathic pulmonary fibrosis.
A retrospective cohort study was conducted in the First Affiliated Hospital, Zhejiang University, wherein 60 consecutive patients with IIM and AE-ILD admitted between February 2011 and April 2019. The GAP-ILD was assessed retrospectively on the basis of gender, age and pulmonary function test.
Patients with AE-ILD (n = 60) were identified and collected, 26 deaths occurred during follow-up, and the non-survivors group presented a higher level of GAP-ILD index (P = 0.005), bacterial infection (P = 0.013), and myositis disease activity assessment (MYOACT) (P = 0.031). The subsequent multivariate logistic regression analysis of overall mortality in AE-ILD revealed that bacterial infection (OR 5.275, P = 0.037) and GAP-ILD index (OR 2.292, P = 0.011) conferred significant risk of mortality. The GAP-ILD index was able to separate patients with AE-ILD into two groups with a statistically significant difference in survival rate (log rank P = 0.002). Satisfactory mortality estimation was maintained in the corresponding GAP-ILD index across the AE-ILD group.
The GAP-ILD model preforms well in risk prediction of mortality among patients with IIM and AE-ILD. Pulmonary bacterial infection can also be taken as an initial predictor of poor prognosis in patients with IIM and AE-ILD that must be taken seriously.
由于特发性炎性肌病（IIM）患者的异质性和个体特异性变量，以及间质性肺疾病急性加重（AE-ILD）的情况，风险预测具有挑战性。我们的目的是评估使用性别年龄生理学ILD（GAP-ILD）模型能否准确预测IIM和AE-ILD患者的死亡率，该临床预测模型先前已在特发性肺纤维化患者中得到验证。
在浙江大学第一附属医院进行了一项回顾性队列研究，纳入了2011年2月至2019年4月期间连续收治的60例IIM和AE-ILD患者。基于性别、年龄和肺功能测试对GAP-ILD进行回顾性评估。
确定并收集了60例AE-ILD患者，随访期间有26例死亡，非存活组的GAP-ILD指数水平更高（P = 0.005）、细菌感染率更高（P = 0.013）以及肌炎疾病活动评估（MYOACT）更高（P = 0.031）。随后对AE-ILD患者总体死亡率进行的多因素逻辑回归分析显示，细菌感染（OR 5.275，P = 0.037）和GAP-ILD指数（OR 2.292，P = 0.011）具有显著的死亡风险。GAP-ILD指数能够将AE-ILD患者分为两组，生存率有统计学显著差异（对数秩检验P = 0.002）。在整个AE-ILD组中，相应的GAP-ILD指数保持了令人满意的死亡率估计。
GAP-ILD模型在IIM和AE-ILD患者的死亡风险预测中表现良好。肺部细菌感染也可作为IIM和AE-ILD患者预后不良的初始预测指标，必须予以重视。
