Combination of BAL and Computed Tomography Differentiates Progressive and Non-progressive Fibrotic Lung Diseases
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Le résumé fourni par la source
Abstract Rationale Identifying patients with pulmonary fibrosis (PF) at risk of progression can guide management. Objectives To explore the utility of combining baseline BAL and computed tomography (CT) in differentiating progressive and nonprogressive PF. Methods The derivation cohort consisted of incident cases of PF for which BAL was performed as part of a diagnostic workup. A validation cohort was prospectively recruited with identical inclusion criteria. Baseline thoracic CT scans were scored for the extent of fibrosis and usual interstitial pneumonia (UIP) pattern. The BAL lymphocyte proportion was recorded. Annualized FVC decrease of >10% or death within 1 year was used to define disease progression. Multivariable logistic regression identified the determinants of the outcome. The optimum binary thresholds (maximal Wilcoxon rank statistic) at which the extent of fibrosis on CT and the BAL lymphocyte proportion could distinguish disease progression were identified. Measurements and Main Results BAL lymphocyte proportion, UIP pattern, and fibrosis extent were significantly and independently associated with disease progression in the derivation cohort (n = 240). Binary thresholds for increased BAL lymphocyte proportion and extensive fibrosis were identified as 25% and 20%, respectively. An increased BAL lymphocyte proportion was rare in patients with a UIP pattern (8 of 135; 5.9%) or with extensive fibrosis (7 of 144; 4.9%). In the validation cohort (n = 290), an increased BAL lymphocyte proportion was associated with a significantly lower probability of disease progression in patients with nonextensive fibrosis or a non-UIP pattern. Conclusions BAL lymphocytosis is rare in patients with extensive fibrosis or a UIP pattern on CT. In patients without a UIP pattern or with limited fibrosis, a BAL lymphocyte proportion of ≥25% was associated with a lower likelihood of progression.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Combination of BAL and Computed Tomography Differentiates Progressive and Non-progressive Fibrotic Lung Diseases
- Date Crossref
- 01/11/2023
- Éditeur
- Oxford University Press (OUP)
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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The Royal Free Hospital Department of Radiology pays non établi dans la noticeÉtablissement de santé
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University College London pays non établi dans la noticeUniversité ou école supérieure
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University of Southern California pays non établi dans la noticeUniversité ou école supérieure
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Imperial College London National Heart and Lung Institute pays non établi dans la noticeUniversité ou école supérieure
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Interstitial Cystitis Association pays non établi dans la noticeOrganisation à but non lucratif
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University College Hospital Department of Radiology pays non établi dans la noticeÉtablissement de santé
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National Health Service pays non établi dans la noticeÉtablissement de santé
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Guy's and St Thomas' NHS Foundation Trust pays non établi dans la noticeÉtablissement de santé
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Royal Brompton Hospital Department of Histopathology pays non établi dans la noticeÉtablissement de santé
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Keck School of Medicine pays non établi dans la noticeUniversité ou école supérieure
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Interstitial Lung Disease Unit pays non établi dans la noticeInstitution
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Department of Radiology pays non établi dans la noticeInstitution
Department of Radiology — The Royal Free Hospital, University College London et University of Southern California, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.