Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, No. 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Afliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
Clin Rheumatol. 2024 Apr;43(4):1381-1392. doi: 10.1007/s10067-024-06899-3. Epub 2024 Feb 12.
To investigate the potential risk factors for mortality in fungal infection in anti-melanoma differentiation-associated gene 5 antibody-positive associated interstitial lung disease (MDA5-ILD).
Patients diagnosed with MDA5-ILD from April 2017 to November 2022 were included. The demographic data, laboratory examinations, therapeutic and follow-up information were recorded. Fungal infection diagnosis was established based on a combinations of host factors, clinical features and mycologic evidences. High-dose corticosteroid therapy was defined as the initial corticosteroid doses > 240mg/d. The primary endpoint was mortality. Potential factors for fungal infection occurrence and prognostic factors were analyzed using logistic regression analysis and Cox proportional hazards regression.
In total, 121 patients with MDA5-ILD were included. During follow-up, 41 (33.9%) patients had suffered fungal infection and 39.0% (16/41) of whom had ever received high-dose corticosteroid therapy. The median interval from corticosteroid use to the occurrence of fungal infection was 29 (10-48) days. The mean survival time of patients with fungal infection was 234.32 ± 464.76 days. The mortality in MDA5-ILD with fungal infection was 85.4% (35/41), which was significantly higher than those without (85.4% VS 56.3%, P < 0.001). High-dose corticosteroid therapy (P = 0.049) was independent risk factor for fungal infection occurrence. Decreased serum albumin level (P = 0.024) and high-dose corticosteroid therapy (P = 0.008) were both associated with increased mortality in MDA5-ILD patients with fungal infection.
Fungal infection is associated with an increased mortality in MDA5-ILD. The serum albumin level and corticosteroid dose should be taken into consideration when treating MDA5-ILD. Key Points • This study showed fungal infection is associated with an increased mortality in MDA5-ILD. In MDA5-ILD patients with fungal infection, the presence of decreased serum albumin level and high-dose corticosteroid therapy were identified as predictors for mortality.
探讨抗黑色素瘤分化相关基因 5 抗体阳性相关间质性肺疾病（MDA5-ILD）合并真菌感染的死亡危险因素。
纳入 2017 年 4 月至 2022 年 11 月期间确诊的 MDA5-ILD 患者，记录其人口统计学资料、实验室检查、治疗及随访信息。真菌感染诊断基于宿主因素、临床特征和微生物学证据的综合判断。大剂量皮质类固醇治疗定义为初始皮质类固醇剂量＞240mg/d。主要终点为死亡率。采用 logistic 回归分析和 Cox 比例风险回归分析潜在的真菌感染发生和预后因素。
共纳入 121 例 MDA5-ILD 患者，随访期间 41 例（33.9%）发生真菌感染，其中 39.0%（16/41）曾接受大剂量皮质类固醇治疗。皮质类固醇使用至真菌感染发生的中位间隔时间为 29（10-48）天。合并真菌感染患者的平均生存时间为 234.32±464.76 天。MDA5-ILD 合并真菌感染患者的死亡率为 85.4%（35/41），明显高于未合并真菌感染患者（85.4%比 56.3%，P＜0.001）。大剂量皮质类固醇治疗（P=0.049）是真菌感染发生的独立危险因素。血清白蛋白水平降低（P=0.024）和大剂量皮质类固醇治疗（P=0.008）均与 MDA5-ILD 合并真菌感染患者的死亡率增加相关。
真菌感染与 MDA5-ILD 患者的死亡率增加相关。在治疗 MDA5-ILD 时，应考虑血清白蛋白水平和皮质类固醇剂量。
本研究显示真菌感染与 MDA5-ILD 患者的死亡率增加相关。在 MDA5-ILD 合并真菌感染患者中，血清白蛋白水平降低和大剂量皮质类固醇治疗是死亡率的预测因素。
