Prognostic value of BAL lymphocytes in connective tissue disease-related interstitial lung disease: An observational study

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Introduction: Connective tissue disease-related interstitial lung disease (CTD-ILD) presents with varied disease courses, emphasizing the need for reliable predictors of progression. The prognostic value of bronchoalveolar lavage (BAL) in CTD-ILD remains underexplored. Aims and objectives: To evaluate the role of BAL fluid lymphocytes in predicting disease progression in patients with CTD-ILD. Methods: This observational study included patients with CTD-ILD undergoing BAL. Disease progression was defined as either FVC decrease >10%, two out of the following three criteria: FVC decrease of 5-10%, worsening symptoms, increased fibrosis on imaging, or any of the following: escalation of treatment, ILD exacerbation, lung transplantation or disease-specific mortality. Logistic regression identified predictors of progression. Time-to-progression was assessed using Kaplan-Meier survival curves. The optimal BAL lymphocyte threshold for predicting progression was identified using the Youden Index and Wilcoxon method. Results: We identified 30 patients (33.7%) with progressive disease and 59 (66.3%) without. Progressors had a significantly higher BAL lymphocyte count compared to non-progressors (31.6 ± 24.8% vs. 14.3 ± 16.5%, p<0.001). BAL lymphocyte count was significantly and independently associated with disease progression (OR, 1.05; 95% CI, 1.02-1.07; p<0.01). A lymphocyte count above 9% was associated with a markedly increased risk of disease progression (OR, 13.14; 95% CI, 4.20.-51.98; p<0.01). Conclusion: BAL lymphocytes were associated with a higher likelihood of disease progression in CTD-ILD. BAL may serve as a comprehensive tool for assessing progression.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.