Acute exacerbation of interstitial lung disease after procedures

Amundson, William H.; Racila, Emilian; Allen, Tadashi; Dinçer, H. Erhan; Tomic, Rade; Bhargava, Maneesh; Perlman, D.; Kim, Hyun Joo

doi:10.1016/j.rmed.2019.02.012

Cited by 44 publications

(37 citation statements)

References 50 publications

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“…Surgical biopsy represents the gold standard [1]. However, we know that every surgical procedure carries a certain risk of morbidity and mortality, especially in patients with advanced pathology and can, although rarely, trigger acute exacerbations, particularly in patients with IPF [24,25,26,27]. The risk–benefit assessment of a diagnostic procedure is therefore essential, bearing in mind that therapeutic relapses sometimes do not significantly change the clinical history of patients.…”

Section: Discussionmentioning

confidence: 99%

Lung Cryobiopsy for the Diagnosis of Interstitial Lung Diseases: A Series Contribution to a Debated Procedure

et al. 2019

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Introduction: Transbronchial cryobiopsy is an alternative to surgical biopsy for the diagnosis of fibrosing interstitial lung diseases, although the role of this relatively new method is rather controversial. Aim of this study is to evaluate the diagnostic performance and the safety of transbronchial cryobiopsy in patients with fibrosing interstitial lung disease. Materials and methods: The population in this study included patients with interstitial lung diseases who underwent cryobiopsy from May 2015 to May 2018 at the Division of Pneumology of San Giuseppe Hospital in Milan and who were retrospectively studied. All cryobiopsy procedures were performed under fluoroscopic guidance using a flexible video bronchoscope and an endobronchial blocking system in the operating room with patients under general anaesthesia. The diagnostic performance and safety of the procedure were assessed. The main complications evaluated were endobronchial bleeding and pneumothorax. All cases were studied with a multidisciplinary approach, before and after cryobiopsy. Results: Seventy-three patients were admitted to this study. A specific diagnosis was reached in 64 cases, with a diagnostic sensitivity of 88%; 5 cases (7%) were considered inadequate, 4 cases (5%) were found to be non-diagnostic. Only one major bleeding event occurred (1.4%), while 14 patients (19%) experienced mild/moderate bleeding events while undergoing bronchoscopy; 8 cases of pneumothorax (10.9%) were reported, of which 2 (2.7%) required surgical drainage. Conclusions: When performed under safe conditions and in an experienced center, cryobiopsy is a procedure with limited complications having a high diagnostic yield in fibrotic interstitial lung disease.

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Section: Discussionmentioning

confidence: 99%

Lung Cryobiopsy for the Diagnosis of Interstitial Lung Diseases: A Series Contribution to a Debated Procedure

et al. 2019

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“…[1][2][3][4][5] Although rare, AE after surgery with general anaesthesia (ie, postoperative AE) may induce a fatal response. 6 Accordingly, the ability to predict the likelihood of postoperative AE is crucial during the planning of surgery with general anaesthesia for patients with ILD.…”

Section: Introductionmentioning

confidence: 99%

Predictors of postoperative acute exacerbation of interstitial lung disease: a case–control study

et al. 2020

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IntroductionPatients with interstitial lung disease (ILD) are known to develop an acute exacerbation (AE) after surgery. Previous studies have evaluated the predictors of postoperative AE. However, it remains unclear whether the results of those studies can be generalised to patients with different types of ILD and/or extrapolated to those who undergo non-pulmonary surgery. This study aimed to elucidate the predictors of the development of AE after surgery with general anaesthesia in patients with ILD.MethodsWe conducted a nested matched case–control study of 700 patients from an initial cohort of 50 840 patients. We excluded those who underwent solid organ or bone marrow transplantation. The cases were patients with ILD who developed AE within 30 days postoperatively, whereas the controls did not develop AE. Each case (n=28) was matched with four controls (n=112) for sex, year of surgery and multiple operations within 30 days. Furthermore, a multivariable conditional logistic regression analysis was used to identify significant predictors, as indicated by a p value of <0.05.ResultsAfter adjusting for potential confounders, the multivariable conditional logistic regression analysis identified honeycombing on CT (OR 3.09; 95% CI 1.07 to 8.92), a per cent predicted FVC <80% (OR 4.21; 95% CI 1.46 to 12.2) and an ARISCAT score ≥45 (OR 6.14; 95% CI 2.10 to 18.0) significantly associated with the development of postoperative AE.ConclusionsWe found that the three factors were independent predictors for the development of postoperative AE in patients with ILD. These predictors are advantageous because they can be readily evaluated before surgery by surgeons and anaesthesiologists even without consulting experienced pulmonologists.

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“…Postoperative AE-ILD is triggered by surgical procedure [7]. Previous reports have shown that postoperative AE-ILD occurs in 9.3% of patients, with a mortality rate of 43.9%, in patients with lung cancer and ILD [8].…”

Section: Introductionmentioning

confidence: 99%

Higher circulatory HMGB1 accelerates postoperative acute exacerbation of interstitial lung disease in lung cancer

Yamaguchi

Nakao

Iwamoto

et al. 2020

Preprint

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Background: Postoperative acute exacerbation of interstitial lung disease (AE-ILD) is a fatal complication in patients with lung cancer and ILD, and it needs to be overcome to improve the long-term outcomes of these patients. However, the molecular target for predicting and preventing this fatal complication remains unclear. High-mobility group box 1 (HMGB1), which is reported to increase due to surgical procedure, activates a pro-inflammatory response associated with acute lung injury. This study aimed to elucidate the association between postoperative AE-ILD and circulatory HMGB1, especially focusing on its predictive potential. Methods: This study included 152 patients with lung cancer and ILD, who underwent radical surgery between January 2011 and August 2019. We measured HMGB1 serum levels, and investigated the factors affecting HMGB1 and the predictive potential of HMGB1 for postoperative AE-ILD.Results: Postoperative AE-ILD was developed in 17 (11.2%) of 152 patients with lung cancer and ILD. HMGB1 serum levels in patients with AE-ILD were significantly higher than those in patients without (median [IQR]: 5.39 [3.29-11.70] ng/mL vs 3.55 [2.07-5.62] ng/mL). Logistic regression analysis revealed that HMGB1 higher levels and longer operative time was independently associated with a higher incidence of postoperative AE-ILD. Furthermore, when HMGB1 and operative time were incorporated into previously reported risk scoring system, the concordance index was 0.876 which is statistically higher than 0.715 calculated by reported scoring system only.Conclusions: Baseline levels of serum HMGB1 could be a promising biomarker for predicting postoperative AE-ILD, especially when combined with operative time. HMGB1 may be a molecular target of this fatal complication to be overcome.

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Acute exacerbation of interstitial lung disease after procedures

Cited by 44 publications

References 50 publications

Lung Cryobiopsy for the Diagnosis of Interstitial Lung Diseases: A Series Contribution to a Debated Procedure

Lung Cryobiopsy for the Diagnosis of Interstitial Lung Diseases: A Series Contribution to a Debated Procedure

Predictors of postoperative acute exacerbation of interstitial lung disease: a case–control study

Higher circulatory HMGB1 accelerates postoperative acute exacerbation of interstitial lung disease in lung cancer

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