Prognosticating Outcomes in Interstitial Lung Disease by Mediastinal Lymph Node Assessment. An Observational Cohort Study with Independent Validation

Abstract Background: Interstitial lung disease (ILD) and its rapid progression (RP) were main contributors to unfavorable outcome of idiopathic inflammatory myopathy (IIM) patients. This study aimed at identifying the clinical value of PET/CT scan in IIM-ILD patients as well as constructing a predicting model for RP-ILD.Methods: Adult IIM-ILD patients who were hospitalized at four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZJU) from Jannuary 1st 2017 to December 31st 2020 were reviewed. PET/CT scan as well as other factors of patients who met the inclusion and exclusion criteria were collected and analyzed.Results: A total of 61 IIM-ILD patients were finally enrolled into this study. Twenty-one patients (34.4%) developed RP-ILD and 24 patients (39.3%) died in follow-up. After false discovery rate (FDR) correction, percent-predicted diﬀusing capacity of the lung for carbon monoxide (DLCO%, P=0.014), bilateral lung mean standard uptake value (SUVmean, P=0.014) and abnormal mediastinal lymph node (P=0.045) were significantly different in comparison between RP-ILD and non-RP-ILD groups. A “DLM” model was hereby established by including the above three values to predict RP-ILD with a cutoff value of ≥2 and an area under the curve (AUC) of 0.905. Higher bilateral lung SUVmean (P=0.019) and spleen SUVmean (P=0.011) were observed in IIM-ILD patients who died within three months, and a moderate correlation was recognized between the two values. Conclusions: Elevated bilateral lung SUVmean and abnormal mediastinal lymph node were associated with RP-ILD in IIM-ILD patients. The “DLM” model was valuable in predicting RP-ILD and demanded further evaluation.

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Prognostic value of mediastinal lymph node enlargement in chronic interstitial lung disease

Diagnostic and Interventional Radiology ◽

10.5152/dir.2021.19585 ◽

2021 ◽

Author(s):

Stefano Grecuccio ◽

◽

Nicola Sverzellati ◽

Elisabetta Uslenghi ◽

Antonella Caminati ◽

...

Keyword(s):

Lymph Node ◽

Interstitial Lung Disease ◽

Lung Disease ◽

Prognostic Value ◽

Mediastinal Lymph Node ◽

Lymph Node Enlargement

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The Its Not JUST Idiopathic pulmonary fibrosis Study (INJUSTIS): description of the protocol for a multicentre prospective observational cohort study identifying biomarkers of progressive fibrotic lung disease

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2019-000439 ◽

2019 ◽

Vol 6 (1) ◽

pp. e000439 ◽

Cited By ~ 2

Author(s):

Fasihul Khan ◽

Iain Stewart ◽

Lucy Howard ◽

Tricia M McKeever ◽

Steve Jones ◽

...

Keyword(s):

Cohort Study ◽

Idiopathic Pulmonary Fibrosis ◽

Pulmonary Fibrosis ◽

Lung Disease ◽

Molecular Mechanisms ◽

Observational Cohort Study ◽

Prospective Observational Cohort Study ◽

Ethical Approval ◽

Observational Cohort ◽

Fibrotic Lung Disease

IntroductionThe Its Not JUST Idiopathic pulmonary fibrosis Study (INJUSTIS) is a multicentre, prospective, observational cohort study. The aims of this study are to identify genetic, serum and other biomarkers that may identify specific molecular mechanisms, reflecting disease endotypes that are shared among patients with progressive pulmonary fibrosis regardless of aetiology. Furthermore, it is anticipated that these biomarkers will help predict fibrotic activity that may identify patterns of disease behaviour with greater accuracy than current clinical phenotyping.Methods and analysis200 participants with the multidisciplinary team confirmed fibrotic lung disease (50 each of rheumatoid-interstitial lung disease (ILD), asbestosis, chronic hypersensitivity pneumonitis and unclassifiable ILD) and 50 idiopathic pulmonary fibrosis participants, recruited as positive controls, will be followed up for 2 years. Participants will have blood samples, lung function tests, quality of life questionnaires and a subgroup will be offered bronchoscopy. Participants will also be given the option of undertaking blinded home handheld spirometry for the first 3 months of the study. The primary end point will be identification of a biomarker that predicts disease progression, defined as 10% relative change in forced vital capacity (FVC) or death at 12 months.Ethics and disseminationThe trial has received ethical approval from the National Research Ethics Committee Nottingham (18/EM/0139). All participants must provide written informed consent. The trial will be overseen by the INJUSTIS steering group that will include a patient representative, and an independent chairperson. The results from this study will be submitted for publication in peer-reviewed journals and disseminated at regional and national conferences.Trial registration numberNCT03670576.

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