Abstract：
OBJECTIVE: Evidence for the benefit of steroid therapy in acute exacerbations (AEs) of idiopathic pulmonary fibrosis (IPF) is limited; however, they remain a cornerstone of management in other fibrotic interstitial lung diseases. This retrospective observational study assesses the effect of steroid treatment on in-hospital mortality in patients with acute exacerbation of fibrotic interstitial lung disease (AE-FILD) including IPF and non-IPF ILDs.
METHODS: AE-FILD cases over a 10-year period were filtered using a code-based algorithm followed by individual case evaluation. Binary logistic regression analysis was used to assess the relationship between corticosteroid treatment (defined as ≥0.5 mg/kg/day of prednisolone-equivalent for ≥3 days within the first 72 h of admission) and in-hospital mortality or need for lung transplantation. Secondary outcomes included readmission, overall survival, requirement for domiciliary oxygen and rehabilitation.
RESULTS: Across two centres a total of 107 AE-FILD subjects were included, of which 46 patients (43%) received acute steroid treatment. The steroid cohort was of younger age with fewer comorbidities but had higher oxygen requirements. Pre-admission FVC and DLCO, distribution of diagnoses and smoking history were similar. The mean steroid treatment dose was 4.59 mg/kg/day. Steroid use appeared to be associated with increased risk of inpatient mortality or transplantation (OR 4.11; 95% CI 1.00-16.83; p = 0.049). In the steroid group, there appeared to be a reduced risk of all-cause mortality in non-IPF patients (HR 0.21; 95% CI 0.04-0.96; p = 0.04) compared to their IPF counterparts. Median survival was reduced in the steroid group (221 vs. 520.5 days) with increased risk of all-cause mortality (HR 3.25; 95% CI 1.56-6.77; p < 0.01).
CONCLUSIONS: In this two-centre retrospective study of 107 patients, AE-FILD demonstrates a high risk of mortality, at a level similar to that seen for AE-IPF, despite steroid treatment. Clinicians should consider other precipitating factors for exacerbations and use steroids judiciously. Further prospective trials are needed to determine the role of corticosteroids in AE-FILD.
METHODS: AE-FILD cases over a 10-year period were filtered using a code-based algorithm followed by individual case evaluation. Binary logistic regression analysis was used to assess the relationship between corticosteroid treatment (defined as ≥0.5 mg/kg/day of prednisolone-equivalent for ≥3 days within the first 72 h of admission) and in-hospital mortality or need for lung transplantation. Secondary outcomes included readmission, overall survival, requirement for domiciliary oxygen and rehabilitation.
RESULTS: Across two centres a total of 107 AE-FILD subjects were included, of which 46 patients (43%) received acute steroid treatment. The steroid cohort was of younger age with fewer comorbidities but had higher oxygen requirements. Pre-admission FVC and DLCO, distribution of diagnoses and smoking history were similar. The mean steroid treatment dose was 4.59 mg/kg/day. Steroid use appeared to be associated with increased risk of inpatient mortality or transplantation (OR 4.11; 95% CI 1.00-16.83; p = 0.049). In the steroid group, there appeared to be a reduced risk of all-cause mortality in non-IPF patients (HR 0.21; 95% CI 0.04-0.96; p = 0.04) compared to their IPF counterparts. Median survival was reduced in the steroid group (221 vs. 520.5 days) with increased risk of all-cause mortality (HR 3.25; 95% CI 1.56-6.77; p < 0.01).
CONCLUSIONS: In this two-centre retrospective study of 107 patients, AE-FILD demonstrates a high risk of mortality, at a level similar to that seen for AE-IPF, despite steroid treatment. Clinicians should consider other precipitating factors for exacerbations and use steroids judiciously. Further prospective trials are needed to determine the role of corticosteroids in AE-FILD.
摘要：
目的：激素治疗对特发性肺纤维化（IPF）急性加重（AEs）有益的证据有限；它们仍然是治疗其他纤维化间质性肺病的基石。这项回顾性观察性研究评估了类固醇治疗对包括IPF和非IPFILD在内的急性加重期纤维化间质性肺病（AE-FILD）患者院内死亡率的影响。
方法：使用基于代码的算法过滤10年的AE-FILD病例，然后进行个例评估。二元logistic回归分析用于评估皮质类固醇治疗（定义为入院前72小时内≥3天的泼尼松龙治疗≥0.5mg/kg/天）与住院死亡率或肺移植需求之间的关系。次要结果包括再入院，总生存率,家庭氧气和康复的要求。
结果：在两个中心，共纳入107名AE-FILD受试者，其中46例(43%)接受急性类固醇治疗。类固醇队列年龄较小，合并症较少，但对氧气的需求较高。入院前FVC和DLCO，诊断和吸烟史的分布相似。平均类固醇治疗剂量为4.59mg/kg/天。使用类固醇似乎与住院患者死亡率或移植风险增加相关(OR4.11;95%CI1.00-16.83;p=0.049)。在类固醇组中，与IPF患者相比,非IPF患者的全因死亡风险降低(HR0.21;95%CI0.04~0.96;p=0.04).类固醇组的中位生存率降低（221vs.520.5天），全因死亡率风险增加（HR3.25；95％CI1.56-6.77；p<0.01）。
结论：在这项对107例患者进行的双中心回顾性研究中，AE-FILD显示了高死亡风险，在与AE-IPF相似的水平上，尽管类固醇治疗。临床医生应考虑其他加重因素，并明智地使用类固醇。需要进一步的前瞻性试验来确定皮质类固醇在AE-FILD中的作用。
方法：使用基于代码的算法过滤10年的AE-FILD病例，然后进行个例评估。二元logistic回归分析用于评估皮质类固醇治疗（定义为入院前72小时内≥3天的泼尼松龙治疗≥0.5mg/kg/天）与住院死亡率或肺移植需求之间的关系。次要结果包括再入院，总生存率,家庭氧气和康复的要求。
结果：在两个中心，共纳入107名AE-FILD受试者，其中46例(43%)接受急性类固醇治疗。类固醇队列年龄较小，合并症较少，但对氧气的需求较高。入院前FVC和DLCO，诊断和吸烟史的分布相似。平均类固醇治疗剂量为4.59mg/kg/天。使用类固醇似乎与住院患者死亡率或移植风险增加相关(OR4.11;95%CI1.00-16.83;p=0.049)。在类固醇组中，与IPF患者相比,非IPF患者的全因死亡风险降低(HR0.21;95%CI0.04~0.96;p=0.04).类固醇组的中位生存率降低（221vs.520.5天），全因死亡率风险增加（HR3.25；95％CI1.56-6.77；p<0.01）。
结论：在这项对107例患者进行的双中心回顾性研究中，AE-FILD显示了高死亡风险，在与AE-IPF相似的水平上，尽管类固醇治疗。临床医生应考虑其他加重因素，并明智地使用类固醇。需要进一步的前瞻性试验来确定皮质类固醇在AE-FILD中的作用。
