Clinical features and outcome of acute exacerbation of interstitial pneumonia: collagen vascular diseases-related versus idiopathic

Respiration. 2012;83(1):20-7. doi: 10.1159/000329893. Epub 2011 Sep 6.

Abstract

Background: Relatively little is known about acute exacerbation (AE) of interstitial pneumonia associated with collagen vascular diseases (CVD-IPs).

Objectives: This study was aimed at clarifying clinical characteristics and outcome in AE of CVD-IPs, compared with those of idiopathic interstitial pneumonias (IIPs).

Methods: We retrospectively reviewed 112 admission cases with suspected AE of CVD-IPs or IIPs during 2003-2009. IIPs were diagnosed with idiopathic pulmonary fibrosis (IPF) or non-IPF, mostly based on radiologic findings. Of these, 15 AEs of CVD-IPs (6 rheumatoid arthritis, 6 dermatomyositis and 3 systemic sclerosis) and 47 AEs of IIPs (13 IPF and 34 non-IPF) were included.

Results: The clinical characteristics in AE of CVD-IPs were similar to those of IIPs, except for younger age (63.3 ± 6.8 vs. 73.8 ± 9.1 years; p = 0.0001) and higher PaO(2)/FiO(2) at the onset of AE (205 ± 81.2 vs. 145 ± 53.8 mm Hg; p = 0.002) in the former. Dermatomyositis-related interstitial pneumonia (IP) showed a relatively indolent onset and was often associated with worsening control of the underlying disease, whereas AE of other CVD-IPs resembled that of IIPs. 90-day mortality of 33% in AE of CVD-IPs was similar to that of IIPs (44%; p = 0.44) or non-IPF (34%; p = 0.94), but was significantly better than that of IPF (69%; p = 0.04).

Conclusion: Clinical features and outcome in AE of CVD-IPs were similar, if not identical, to those of IIPs, having a significant impact on the clinical course. AE of advanced IPF with typical radiologic features seems to have higher mortality compared with other forms of IP.

Publication types

  • Comparative Study

MeSH terms

  • Acute Disease
  • Aged
  • Biopsy
  • Bronchoalveolar Lavage
  • Collagen Diseases / complications*
  • Collagen Diseases / diagnosis
  • Collagen Diseases / mortality
  • Disease Progression
  • Female
  • Follow-Up Studies
  • Humans
  • Idiopathic Pulmonary Fibrosis / complications*
  • Idiopathic Pulmonary Fibrosis / diagnosis
  • Idiopathic Pulmonary Fibrosis / mortality
  • Japan / epidemiology
  • Lung / diagnostic imaging
  • Lung / pathology
  • Lung Diseases, Interstitial / diagnosis
  • Lung Diseases, Interstitial / etiology*
  • Lung Diseases, Interstitial / mortality
  • Male
  • Middle Aged
  • Radiography, Thoracic
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Survival Rate / trends
  • Tomography, X-Ray Computed
  • Vascular Diseases / complications*
  • Vascular Diseases / diagnosis
  • Vascular Diseases / mortality