Materiały źródłowe

• #1 Prognostic factors in chronic hypersensitivity pneumonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9489027/

  Hypersensitivity pneumonitis (HP) is an immunologically mediated lung disease resulting from exposure to inhaled environmental antigens. Prognosis is variable, with a subset of patients developing progressive fibrosis leading to respiratory failure and death. Therefore, there is an urgent need to identify factors which predict prognosis and survival in patients with HP. […] While no single marker has been demonstrated to accurately and reliably predict prognosis, older age, more severe impairment of pulmonary function at baseline and established fibrosis on either biopsy or high-resolution computed tomography are consistently associated with worse survival. […] The vast majority of existing studies are retrospective, and this review identifies a need for prospective longitudinal studies with serial assessment of respiratory health to ascertain factors associated with nonfatal deterioration. Future developments, including the development of HP-specific composite scores may help further improve our ability to predict outcomes for individual patients.

• #2 Predictors of Progression and Mortality in Patients with Chronic Hypersensitivity Pneumonitis: Retrospective Analysis of Registry of Fibrosing Interstitial Lung Diseases

  https://www.mdpi.com/2075-1729/13/2/467

  Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) resulting from an immune-mediated response in susceptible and sensitized individuals to a large variety of inhaled antigens. Chronic HP with a fibrotic phenotype is characterized by disease progression and a dismal prognosis. […] The most significant predictors of adverse outcomes were a DLco < 50% predicted, an SpO2 at the end of a six-minute walk test (6-MWT) < 85%, and a GAP score ≥ 4 points. [...] Patients with a fibrotic HP phenotype are characterized by worsening clinical symptoms, decreased lung function, decreased quality of life, development of respiratory failure, and decreased survival. [...] The most significant predictors of progression and mortality were a baseline DLco <50% predicted, an SpO2 at the end of 6-MWT < 85%, an RA area ≥ 18 mm², and a GAP score ≥4 points.

• #3 Prognostic factors in chronic hypersensitivity pneumonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9489027/

  Baseline lung function tests have prognostic value in patients with IPF, reflected in the GAP index tool. […] Multiple studies have shown that the presence of fibrosis, regardless of whether diagnosed on histopathology or radiology, gives a worse survival than HP without established fibrosis. […] The presence of established fibrosis on biopsy is an indicator of worse survival. […] The presence of a UIP pattern of fibrosis has consistently been identified as a poor prognostic marker. […] These results demonstrate the impact of genetic factors in the prognosis and clinical course of HP. […] Older patients and those with more severe impairment of lung physiology at baseline have higher mortality. […] The presence of fibrosis, whether identified on CT or biopsy is consistently associated with increased mortality, while certain radiological features, particularly honeycomb fibrosis, more extensive disease and PVV have been all been identified as predicting mortality. […] Given that the identified predictors of this poor outcome were a UIP pattern of fibrosis and higher numbers of fibrotic foci, both features of IPF, the possibility of a misdiagnosis in these patients must be raised.

• #4 Prognostic factors in chronic hypersensitivity pneumonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9489027/

  Older age is widely reported to be associated with increased mortality. […] Increasing age has also been associated with worse survival in multivariate survival analyses in cohorts from Spain, Mexico, Brazil and the UK. […] Several studies have reported that male sex is associated with worse survival. […] The influence of ethnicity on survival has only been explored in a small number of cohort studies. […] The impact of ongoing IA exposure on disease progression was investigated in a recent retrospective study of 202 patients in a Belgian cohort. […] Failure to identify an IA makes definitively avoiding further exposure impossible. […] The prognostic implication of identified versus unidentified IA in chronic fibrotic HP was investigated in a North American cohort of 142 patients.

• #5 Prognostic factors in chronic hypersensitivity pneumonitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9489027/

  A wide range of IAs have been identified as causes of HP, with the most common being avian proteins, moulds and nontuberculous mycobacteria in metal-working fluid. […] There is a significant body of evidence that suggests smoking is associated with worse overall survival in patients with HP. […] The presence of PH was associated with significantly worse survival over the study period, a significantly stronger predictor of survival than FVC and DLCO. […] The presence of coexistent lung pathologies is recognised in patients with fibrotic ILDs, and combined pulmonary fibrosis and emphysema (CPFE) is considered a distinct clinical syndrome. […] A recent study of 233 patients with HP found evidence of PPFE in 40% of patients with HP, and PPFE of marked severity in 23%. […] Given the immune-mediated pathogenesis of HP, some researchers have hypothesised that the presence of other autoimmune conditions may be associated with disease course.

• #6 Predictors of Progression and Mortality in Patients with Chronic Hypersensitivity Pneumonitis: Retrospective Analysis of Registry of Fibrosing Interstitial Lung Diseases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9965638/

  Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) resulting from an immune-mediated response in susceptible and sensitized individuals to a large variety of inhaled antigens. Chronic HP with a fibrotic phenotype is characterized by disease progression and a dismal prognosis. The aim of this study was to identify predictors of progression and mortality in patients with chronic HP in real clinical practice. […] The most significant predictors of adverse outcomes were a DLco 50% predicted, an SpO2 at the end of a six-minute walk test (6-MWT) 85%, and a GAP score 4 points. […] Early detection of the predictors of an adverse prognosis of chronic HP is necessary for the timely initiation of antifibrotic therapy. […] The most significant predictors of progression and mortality were a baseline DLco 50% predicted, an SpO2 at the end of 6-MWT 85%, an RA area 18 mm2, and a GAP score 4 points.

• #7 Predictors of Progression and Mortality in Patients with Chronic Hypersensitivity Pneumonitis: Retrospective Analysis of Registry of Fibrosing Interstitial Lung Diseases

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9965638/

  The predominance of the fibrotic phenotype (91.8%) of chronic HP in our study explains the high prevalence of the progressive course of HP (30.3%) and the marked mortality (14.5%). […] Our findings are consistent with the data of the study by Lama et al., who showed that in patients with idiopathic interstitial pneumonias (IIPs), desaturation in 6-MWT was associated with an increased risk of death. […] We found that the most important prognostic factors for chronic HP are a DLco less than 50% predicted, an SpO2 at the end of 6-MWT less than 85%, and an RA 18 mm2. […] The most significant predictors of progression and mortality were a baseline DLco 50% predicted, an SpO2 at the end of 6-MWT 85%, and a GAP score 4 points.

• #8 Predictors of Progression and Mortality in Patients with Chronic Hypersensitivity Pneumonitis: Retrospective Analysis of Registry of Fibrosing Interstitial Lung Diseases

  https://www.mdpi.com/2075-1729/13/2/467

  The course of progressive pulmonary fibrosis is comparable to that of IPF, which was confirmed by a comparison of post hoc studies of INPULSIS and INBUILD data. […] The predominance of the fibrotic phenotype (91.8%) of chronic HP in our study explains the high prevalence of the progressive course of HP (30.3%) and the marked mortality (14.5%). […] Our findings are consistent with the data of the study by Lama et al., who showed that in patients with idiopathic interstitial pneumonias (IIPs), desaturation in 6-MWT was associated with an increased risk of death. […] We found that the most important prognostic factors for chronic HP are a DLco less than 50% predicted, an SpO2 at the end of 6-MWT less than 85%, and an RA ≤ 18 mm². […] The results of the first meta-analysis of the risk factors for death in patients with chronic HP were recently published, covering 3077 patients from 21 studies. According to the data obtained with multivariate analysis, the following predictors of poor prognosis in chronic HP were identified: age, male gender, honeycombing on HRCT, and traction bronchiectasis on HRCT.

• #9 Comorbidities and survival in patients with chronic hypersensitivity pneumonitis | Respiratory Research | Full Text

  https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-020-1283-8

  Chronic Hypersensitivity Pneumonitis (cHP) is a fibrotic interstitial lung disease (ILD) resulting from repeated exposure to an offending antigen. Prognostication in cHP remains challenging, and the relationship between comorbidities and survival has yet to be characterized. The aim of this study was to describe the relationship between comorbid conditions and survival in patients with cHP. […] In general, deceased patients had more comorbidities than survivors (p=0.005), yet there was no association between the absolute number of comorbidities and survival. […] Comorbidities are common in cHP are associated with survival. Further work should determine whether interventions for these specific comorbidities can positively affect survival. […] The long-term prognosis of patients with cHP is associated with the extent of radiologic fibrosis, a lack of identified exposure, older age, lower forced vital capacity (FVC) at baseline and positive smoking history.

• #10 Comorbidities and survival in patients with chronic hypersensitivity pneumonitis | Respiratory Research | Full Text

  https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-020-1283-8

  In this cohort, a history of pulmonary hypertension, diabetes or diastolic dysfunction were associated with worse survival. […] However, there appears to be a clinical meaningful effect of cardiovascular diseases on survival in cHP which highlights importance of identification and management of comorbidities in patients with cHP. Further studies are needed to fully clarify the importance of comorbidities on prognosis in patients diagnosed with cHP, and to determine whether specific treatments may positively impact outcomes in this patient population.

• #11 Long-term outcomes in patients with immune checkpoint inhibitor induced pneumonitis | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/10/1/e001342

  Of the 78 patients (48 males; median age 64 (range 2881)), 52 patients required at least 1 hospital admission related to pneumonitis. […] A total of 25 patients experienced poor short-term outcomes (including 6 referred to hospice, 11 discharged to rehabilitation and 9 deaths). […] Median duration of follow-up was 8.3 months (range 0.2110.6 months), and 29 patients (37%) were alive at last follow-up. […] Patients admitted to the hospital were more likely to die (p=0.002) and less likely to receive additional treatment (p0.0001) or survive for 12 months with no evidence of disease (p=0.02). […] ICI-pneumonitis has a high likelihood of causing hospitalisation and poor outcomes, including death. […] Patients admitted to the hospital for pneumonitis are more likely to die from pneumonitis and less likely to have long-term survival.

• #12 Long-term outcomes in patients with immune checkpoint inhibitor induced pneumonitis | BMJ Open Respiratory Research

  https://bmjopenrespres.bmj.com/content/10/1/e001342

  This information can guide clinicians in predicting which patients may have more favourable outcomes at the time of diagnosis with immunotherapy-induced pneumonitis. […] Among the patients who did not die from pneumonitis, 29 (38%) died in less than 1year from cancer or cancer-related complications while 18 (23%) survived greater than 1year with additional treatment and 16 (21%) survived greater than 1year with no evidence of disease progression. […] Patients who were never admitted were less likely to die from pneumonitis and more likely to receive additional treatment, survive greater than 1year with treatment, and survive greater than 1year with no evidence of disease compared with patients admitted to the ICU or the floor. […] This study shows that for patients who develop pneumonitis, admission to either the ICU or general floor portends a poor prognosis with respect to short-term and long-term survival.

• #13 Predicting radiation pneumonitis in lung cancer using machine learning and multimodal features: a systematic review and meta-analysis of diagnostic accuracy | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-024-13098-5

  Improving the accuracy of diagnosing and predicting RP at an early stage is crucial for lung cancer patients, yet the traditional methods for diagnosing RP mainly rely on clinical symptoms, imaging findings, and laboratory tests. […] The onset of RP varies significantly, ranging from one week to nine months post-treatment. […] ML prediction models provide personalized diagnostic and risk stratification insights preclinically, helping prevent severe RP, irreversible loss of lung function, and shorten recovery time. […] However, despite the potential of ML algorithms demonstrated by our study, it is essential to acknowledge several limitations when applying them in clinical practice. […] Our systematic review and meta-analysis indicate that multimodal machine learning (ML) algorithms have potential in predicting radiation pneumonitis (RP) in lung cancer patients.

• #14 Predicting radiation pneumonitis in lung cancer using machine learning and multimodal features: a systematic review and meta-analysis of diagnostic accuracy | BMC Cancer | Full Text

  https://bmccancer.biomedcentral.com/articles/10.1186/s12885-024-13098-5

  A total of 1,406 patients with primary lung cancer were included in this systematic review, drawing data from 9 studies. The pooled analysis revealed a sensitivity of 0.74 [0.580.85] and a specificity of 0.91 [0.870.95] for machine learning models in diagnosing radiation pneumonitis. The positive likelihood ratio (PLR) was 8.69 [5.2114.50], the negative likelihood ratio (NLR) was 0.28 [0.160.49], and the diagnostic odds ratio (DOR) was 30.73 [11.9678.97]. The area under the curve (AUC) was 0.93 [0.900.95], indicating excellent diagnostic performance. […] Overall, machine learning models incorporating multimodal characteristics demonstrated 75% accuracy in predicting moderate to severe radiation pneumonitis. […] In conclusion, by integrating the current machine learning (ML) algorithm’s ability in big data mining, a predictive model can be constructed by combining multi-modal features such as genetics, imaging, and cell factors.

• #15 Prediction of Radiation Pneumonitis by Dose-volume Histogram Parameters in Lung Cancer–A Systematic Review

  https://ir.lib.uwo.ca/epidempub/20/

  BACKGROUND AND PURPOSE: To perform a systematic review of the predictive ability of various dose-volume histogram (DVH) parameters (V(dose), mean lung dose (MLD), and normal tissue complication probability (NTCP)) in the incidence of radiation pneumonitis (RP) caused by external-beam radiation therapy. […] Most studies did show an association between DVH parameters and RP risk. However, overall accuracy, sensitivity, specificity, and positive predictive value were generally poor to fair for all three classes of DVH metrics. […] An association between DVH parameters and RP risk has been demonstrated in the literature. However, the ideal DVH metric with excellent operating characteristics, either alone or in a model with other predictive variables, for RP risk prediction has not yet been identified.

• #16 Open resource of clinical data from patients with pneumonia for the prediction of COVID-19 outcomes via deep learning | Nature Biomedical Engineering

  https://www.nature.com/articles/s41551-020-00633-5

  Data from patients with coronavirus disease 2019 (COVID-19) are essential for guiding clinical decision making, for furthering the understanding of this viral disease, and for diagnostic modelling. […] We show the utility of the database for prediction of COVID-19 morbidity and mortality outcomes using a deep learning algorithm trained with data from 1,170 patients and 19,685 manually labelled CT slices. […] For morbidity outcomes, the area under the curve (AUC) values of HUST-19 are 0.978, 0.921 and 0.931 for predicting negative cases (control), mild or regular (type I) and severe or critically ill (type II) patients, respectively. […] For mortality outcomes, we merged the two cohorts and achieved an AUC value of 0.856 for predicting deceased cases. […] This resource can be useful for retrospective analysis purposes and for improving the diagnosis and treatment of patients with COVID-19.

• #17 Prognostic accuracy of visual lung damage computed tomography score for mortality prediction in patients with COVID-19 pneumonia: a systematic review and meta-analysis | Egyptian Journal of Radiology and Nuclear Medicine | Full Text

  https://ejrnm.springeropen.com/articles/10.1186/s43055-022-00741-z

  Our results have shown that CT-SS has acceptable prognostic accuracy for mortality prediction in COVID-19 patients. […] Therefore, CT-SS could be considered as an appropriate prognostic factor for mortality prediction in patients with COVID-19 pneumonia. […] The results of our meta-analysis showed that CT-SS has, respectively, achieved pooled sensitivity and specificity values of 67% (95% CI, 5975%) and 79% (95% CI, 74 84%) in mortality prediction of COVID-19 patients. […] In summary, in ROC curve analysis, a considerable area under the curve was achieved for CT-SS. Therefore, CT-SS has acceptable performance for mortality prediction in COVID-19 patients. […] From the results, it could be concluded that CT-SS has acceptable prognostic accuracy for mortality prediction in COVID-19 patients.

• #18 Development of a new prognostic model to predict pneumonia outcome using artificial intelligence-based chest radiograph results | Scientific Reports

  https://www.nature.com/articles/s41598-024-65488-1

  This study aimed to develop a new simple and effective prognostic model using artificial intelligence (AI)-based chest radiograph (CXR) results to predict the outcomes of pneumonia. […] Therefore, a new prognostic model incorporating AI-based CXR results along with traditional pneumonia severity score could be a simple and useful tool for predicting pneumonia outcomes in clinical practice. […] In the present study, we showed that a new prognostic score composed of AI-based CXR results improved the prediction of pneumonia prognosis when combined with the previously known pneumonia severity score. […] Our findings showed that the power of predicting the patients prognosis and mortality increased when the consolidation score on CXRs presented by AI was combined with the patients clinical characteristics.

• #19 Development of a new prognostic model to predict pneumonia outcome using artificial intelligence-based chest radiograph results | Scientific Reports

  https://www.nature.com/articles/s41598-024-65488-1

  Therefore, combining AI-based CXR results to the simple CURB-65 had additive and practical value in clinical use for predicting pneumonia outcomes and had the potential to be widely utilized clinically. […] In conclusion, our study demonstrates that a new prognostic model incorporating AI-based CXR result, along with traditional pneumonia severity scores, could provide a simple and effective method for predicting pneumonia outcomes.

• #20 Pneumonitis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/24810-pneumonitis

  With early diagnosis and treatment, the outlook for pneumonitis is good. If you have acute pneumonitis, your symptoms may go away within a few days after removing the irritant from your environment. […] Subacute cases of pneumonitis fall between acute and chronic. They usually occur due to long-term exposure to low levels of irritants. Your symptoms may last a few months, and you typically need medication or therapy. […] Chronic pneumonitis damage is usually permanent. However, medication and therapy can help reduce the severity of your symptoms. […] It depends. With proper diagnosis and treatment, you can fully recover from acute and subacute cases of pneumonitis. You usually can’t make a full recovery from severe cases of pneumonitis. However, medication and therapy can help make your symptoms more manageable.

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