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.
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。