Chronic hypersensitivity pneumonitis is associated with an increased risk of venous thromboembolism: a retrospective cohort study

Abstract

Background Idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis share commonalities in pathogenesis shifting haemostasis balance towards the procoagulant and antifibrinolytic activity. Several studies have suggested an increased risk of venous thromboembolism in IPF. The association between venous thromboembolism and chronic hypersensitivity pneumonitis has not been studied yet. Methods A retrospective cohort study of IPF and chronic hypersensitivity pneumonitis patients diagnosed in single tertiary referral center between 2005 and 2018 was conducted. The incidence of symptomatic venous thromboembolism was evaluated. Risk factors for venous thromboembolism and survival among those with and without venous thromboembolism were assessed. Results A total of 411 (259 IPF and 152 chronic hypersensitivity) patients were included (mean age 66.7 ± 8.4 vs 51.0 ± 13.3 years, respectively). There were 12 (4.6%) incident cases of venous thromboembolism in IPF and 5 (3.3%) in chronic hypersensitivity pneumonitis cohort. The relative risk (RR) of venous thromboembolism in chronic hypersensitivity pneumonitis was not significantly different to that found in patients with IPF (7.1 vs 11.8/1000 person-years, RR 1.661 95% CI 0.545–6.019, respectively). The treatment with systemic steroids (OR 5.38; 95% CI 1.65–18.8, p = 0.006) and GAP stage 3 (OR 7.85; 95% CI 1.49–34.9; p = 0.037) were significant risk factors for venous thromboembolism in IPF. Arterial hypertension and pulmonary hypertension significantly increased risk of venous thromboembolism in chronic hypersensitivity pneumonitis. There were no significant differences in survival between patients with and without venous thromboembolism. Conclusions The patients with chronic hypersensitivity pneumonitis have a marked increase in the risk of venous thromboembolism, similar to the patients with IPF. Venous thromboembolism does not affect the survival of patients with IPF and chronic hypersensitivity pneumonitis.

A 56-year-old patient with pigeon breeder’s lung, with fibrosis and sepsis-related cardiogenic shock in the course of fungal-bacterial infection – case report

“…According to the literature, HP with fibrosis is accompanied by a significant risk of venous thrombosis and pulmonary embolism [15]. The presented patient's clinical presentation supported the diagnosis of pulmonary embolism, the origin of which was most likely venous thrombosis of the lower extremities.…”

A 35-month-old boy who ingested laundry detergent pods and underwent veno-pulmonary extracorporeal membrane oxygenation support

“…In ARDS, decreased fibrinolysis and increased coagulation activity can lead to a procoagulant state (11). Hypersensitivity pneumonitis may predispose patients to thromboembolism, possibly via inflammation and allergy-triggered activation of the coagulation cascade (12,13). In the present case, severe ARDS and suspicious hypersensitivity pneumonitis might have contributed to uncontrollable thrombosis at the transfer to our hospital.…”

Incidence and risk factors of venous thrombotic events in patients with interstitial lung disease during hospitalization

“…Meanwhile, higher incidence of VTE in IPF was also observed of 3.5%. A retrospective study by Sobiecka M et al [31] on 441 patients with ILD showed that HP and IPF had similar VTE incidence rates of 3.3% and 4.6%, respectively. We further demonstrated similar VTE incidence between these two ILD types (HP, 3.6%; IPF, 3.5%).…”