scholarly journals Characteristic chest CT findings for progressive cavities in Mycobacterium avium complex pulmonary disease: a retrospective cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yohei Oshitani ◽  
Seigo Kitada ◽  
Ryuya Edahiro ◽  
Kazuyuki Tsujino ◽  
Hiroyuki Kagawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Failure ◽  
Disease Progression ◽  
Pulmonary Disease ◽  
Mycobacterium Avium ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Internal Diameter ◽  
Ct Findings ◽  
Progressive Group

Abstract Background Although cavities are an important finding in Mycobacterium avium complex pulmonary disease (MAC-PD), there is little information regarding the types of cavities that indicate disease progression. This study was performed to identify cavity characteristics that were associated with disease progression in patients with MAC-PD. Methods This retrospective cohort study included 97 patients presenting with MAC-PD with cavities between December 2006 and June 2016. We compared initial and final computed tomography (CT) findings, classified 52 and 45 patients in the progressive and non-progressive cavity groups, respectively, and examined the progression-related imaging features in initial CT images. A progressive cavity was defined by more than two-fold increase in internal diameter or emergence of a new cavity around the initial cavity. Results Patients in the progressive group were older (p < 0.001), had a lower body mass index (p = 0.043), and showed higher diabetes complication rates (p = 0.005). The initial CT in the progressive group showed a longer maximum internal diameter of the cavity (p < 0.001) and higher rates of cavities close to the chest wall (p < 0.001), multiple cavities (p = 0.023), consolidation around the cavity (p < 0.001), atelectasis (p = 0.011), and pleural thickening (p < 0.001). Multivariable logistic regression analysis revealed that the maximum internal diameter of the cavity (odds ratio [OR]: 1.11, 95% confidence interval [CI]: 1.02–1.21; p=0.012) and consolidation around the cavity (OR: 16.15, 95% CI: 4.05–64.46; p < 0.001) were significantly associated with progressive cavities. In cavities with a maximum internal diameter of ≥10 mm and simultaneous consolidation, the probability of progression was as high as 96.2%. The 10-year mortality rates in the progressive and non-progressive cavity groups were 46.7 and 9.8% (p < 0.001), respectively, while the 10-year respiratory failure rates were 28.1 and 0%, respectively (p < 0.001). Conclusions Large cavity size and consolidation on CT showed strong relationships with disease progression, which led to respiratory failure and high mortality rate.

scholarly journals Switching antifibrotics in patients with idiopathic pulmonary fibrosis: a multi-center retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuzo Suzuki ◽  
Kazutaka Mori ◽  
Yuya Aono ◽  
Masato Kono ◽  
Hirotsugu Hasegawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Propensity Score ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Disease Progression ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Survival Times ◽  
Antifibrotic Therapy ◽  
Median Period

Abstract Background Currently, there are two antifibrotics used to treat idiopathic pulmonary fibrosis (IPF): pirfenidone and nintedanib. Antifibrotics slow disease progression by reducing the annual decline of forced vital capacity (FVC), which possibly improves outcomes in IPF patients. During treatment, patients occasionally switch antifibrotic treatments. However, prognostic implication of changing antifibrotics has not yet been evaluated. Methods This multi-center retrospective cohort study examined 262 consecutive IPF patients who received antifibrotic therapy. Antifibrotic agents were switched in 37 patients (14.1%). The prognoses were compared between the patient cohort that switched antifibrotics (Switch-IPF) and those without (Non-Switch-IPF) using propensity-score matched analyses. Results The median period between the initiation of antifibrotic therapy and the drug switch was 25.8 (12.7–35.3) months. The most common reasons for the switch were disease progression (n = 17) followed by gastrointestinal disorders (n = 12). Of the 37 patients that switched antifibrotics, only eight patients disrupted switched antifibrotics by their adverse reactions. The overall prognosis of the Switch-IPF cohort was significantly better than the Non-Switch-IPF cohort (median periods: 67.2 vs. 27.1 months, p < 0.0001). In propensity-score matched analyses that were adjusted to age, sex, FVC (%), history of acute exacerbation, and usage of long-term oxygen therapy, the Switch-IPF cohort had significantly longer survival times than the Non-Switch-IPF group (median 67.2 vs. 41.3 months, p = 0.0219). The second-line antifibrotic therapy showed similar survival probabilities than those in first-line antifibrotic therapy in multistate model analyses. Conclusion Switching antifibrotics is feasible and may improve prognosis in patients with IPF. A further prospective study will be required to confirm clinical implication of switching the antifibrotics.

scholarly journals Recurrence of Colonic Diverticulitis: Identifying Predictive CT Findings—Retrospective Cohort Study

Radiology ◽  
2017 ◽  
Vol 285 (3) ◽  
pp. 850-858 ◽  
Author(s):  
Elliot C. Dickerson ◽  
Suzanne T. Chong ◽  
James H. Ellis ◽  
Kuanwong Watcharotone ◽  
Bin Nan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Colonic Diverticulitis ◽  
Ct Findings

scholarly journals A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis

2021 ◽  
pp. 00953-2020
Author(s):  
Syeda Nafisa ◽  
Ben Messer ◽  
Beatrice Downie ◽  
Patience Ehilawa ◽  
William Kinnear ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Failure ◽  
Natural History ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Neuromuscular Disorders ◽  
Inspiratory Muscle ◽  
Diaphragmatic Palsy ◽  
Infection And Inflammation ◽  
Diaphragmatic Weakness

The diaphragm is the main inspiratory muscle, and diaphragmatic weakness can lead to respiratory failure. Diaphragmatic weakness or paralysis commonly presents in association with more generalised neuromuscular disorders. However, it can be caused by other pathologies, such as trauma, compression, infection and inflammation [1]. Isolated diaphragmatic palsy (DP) is well-described [2], but often missed in adults [3], especially in bilateral diaphragmatic palsy (BDP) where both domes of the diaphragm are elevated.

scholarly journals Management of patients with pulmonary mycobacteriosis in France: a multicenter retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pascale Bemer ◽  
Olivia Peuchant ◽  
Hélène Guet-Revillet ◽  
Julien Bador ◽  
Charlotte Balavoine ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prognostic Factors ◽  
Mycobacterium Avium ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Nontuberculous Mycobacteria ◽  
Great Variability ◽  
Microbiological Characteristics ◽  
Smear Negative

Abstract Background Recent studies report very low adherence of practitioners to ATS/IDSA recommendations for the treatment of nontuberculous mycobacteria pulmonary disease (NTM-PD), as well as a great variability of practices. Type of management could impact prognosis. Methods To evaluate management and prognosis of patients with NTM-PD cases with respect to ATS recommendations, we conducted a multicenter retrospective cohort study (18 sentinel sites distributed throughout France), over a period of six years. We collected clinical, radiological, microbiological characteristics, management and outcome of the patients (especially death or not). Results 477 patients with NTM-PD were included. Respiratory comorbidities were found in 68% of cases, tuberculosis sequelae in 31.4% of patients, and immunosuppression in 16.8% of cases. The three most common NTM species were Mycobacterium avium complex (60%), M. xenopi (20%) and M. kansasii (5.7%). Smear-positive was found in one third of NTM-PD. Nodulobronchiectatic forms were observed in 54.3% of cases, and cavitary forms in 19.1% of patients. Sixty-three percent of patients were treated, 72.4% of patients with smear-positive samples, and 57.5% of patients with smear-negative samples. Treatment was in adequacy with ATS guidelines in 73.5%. The 2-year mortality was 14.4%. In the Cox regression, treatment (HR = 0.51), age (HR = 1.02), and M. abscessus (3.19) appeared as the 3 significant independent prognostic factors. Conclusion These findings highlight the adequacy between French practices and the ATS/IDSA guidelines. Treatment was associated with a better survival.

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