Serum C-reactive protein is associated with earlier mortality across different interstitial lung diseases

CD206 and dust particles are prognostic biomarkers of progressive fibrosing interstitial lung disease associated with air pollutant exposure

Current management strategies for progressive fibrosing interstitial lung disease (PF-ILD) and non-PF-ILD differ significantly, underscoring the need for early identification of PF-ILD patients. We analyzed the expression of macrophage markers and the number of dust particles (DP) in lung tissue, as well as complete blood count and blood chemistry tests to identify biomarkers of PF-ILD, and examined the effect of certain pollutants on these biomarkers. Lung biopsies were collected from 73 non-PF-ILD patients and 36 PF-ILD patients. DP were quantified in alveolar wall cells (DP-aw) and desquamated epithelial cells (DP-desq) using polarizing light microscopy. Expression of CD206, transforming growth factor β1 (TGF-β1), connective tissue growth factor (CTGF), C-X-C motif ligand 13 (CXCL13), fibroblast growth factor 2 (FGF-2), tumor necrosis factor α (TNFα), and interleukin 1β (IL-1β) was assessed in lung tissue by immunohistochemistry. The numbers of DP-desq, pulmonary expression of CXCL13, IL-1β and CD206 were higher in ILD patients resided for ≥ 15 days per year in places with 24-hour ambient PM10 level of ≥ 50 µg/m3 compared with ILD patients exposed for < 15 days per year to the similar PM10 concentration. Additionally, CXCL13 expression in lung tissue was higher in smoking ILD patients than in non-smoking ILD patients. Compared with non-PF-ILD patients, PF-ILD patients exhibited higher numbers of DP-aw and DP-desq, as well as increased expression of CD206, CXCL13, IL-1β, TGF-β1, and CTGF in lung tissue. Elevated blood neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocyte ratios were also observed in PF-ILD patients. These biomarkers were found to be independent predictors of PF-ILD. A regression logistic model incorporating NLR, CD206, and DP-desq predicted PF-ILD with an AUC of 0.847, sensitivity of 84.6%, and specificity of 83.3%. Our findings may be useful in predicting PF-ILD and highlight the need for reducing pollutant emission.

Predictive Value of Preoperative Hypersensitive C-Reactive Protein in the Incidence of Postoperative Cognitive Impairment in Valvular Disease Patients: A Retrospective Study

Objective

Postoperative cognitive dysfunction (POCD) is associated with adverse outcomes of cardiac surgery. This study investigated the potential of pre-operative hypersensitive C-reactive protein (Hs-CRP) as a prognostic indicator of POCD in valvular disease (VHD).

Methods

This study retrospectively analyzed 372 VHD patients admitted to the Department of Cardiac Surgery, Fujian Medical University Union Hospital from January 2024 to July 2024. POCD was evaluated by neuropsychological examination before and one month after surgery. Demographics, disease history, blood biochemical parameters, and perioperative data were collected. Patients were divided into a POCD group (N = 103) and a non-POCD group (N = 269) according to the occurrence of POCD. A logistic regression model was used to analyze the relationship between Hs-CPR and POCD in VHD patients.

Results

The 1-month incidence of POCD in VHD patients was 27.6%. There was statistical significance in age and years of education between the two groups (P = 0.047, P = 0.001). The red blood cell count in the POCD group was lower than that in the non-POCD group (P = 0.025), and the Hs-CRP and mechanical ventilation duration in the POCD group was higher than that in the non-POCD group, with statistical significance (P < 0.001). No significant differences were observed in the results of demographic characteristics and other laboratory measures. The incidence of hospitalization days, ICU stay time, acute renal insufficiency, and new cerebral infarction in the POCD group were higher than those in the non-POCD group (P < 0.001, P < 0.001, P = 0.001, P = 0.029). Univariate and multivariate analysis showed that Hs-CRP was an independent risk factor for POCD in patients undergoing surgery for VHD disease.

Conclusion

Our study shows that preoperative Hs-CRP is significantly elevated in POCD patients undergoing VHD surgery, and preoperative Hs-CRP is an independent predictor of POCD.

Exercise-Induced Oxygen Desaturation and Outcomes After Nintedanib Therapy for Fibrosing Interstitial Lung Disease in Patients Without Dyspnea

Background: The degree of exercise-induced oxygen desaturation and outcomes following antifibrotic drug therapy in asymptomatic patients with fibrosing interstitial lung disease (FILD) remain unclear. Methods: We compared clinical data, incidence of annual FILD progression, overall survival, and tolerability after initiating nintedanib between 58 patients with dyspnea and 18 patients without. Annual FILD progression was defined as >10% decrease in forced vital capacity (FVC), >15% decrease in diffusing capacity of the lungs for carbon monoxide (DLCO), developing acute exacerbations, or FILD-related death within 1 year of starting nintedanib. Outcomes between the two groups were adjusted for covariates, including age, gender, FVC, DLCO, and diagnosis of idiopathic pulmonary fibrosis, all known prognostic factors for FILD. Results: In 6-min walk test, incidence of decrease to <90% of SpO2 was significantly lower in non-dyspnea group than in dyspnea group (24% vs. 55%, p = 0.028), but incidence of >4% decreases showed no significant difference (71% vs. 89%, p = 0.11) The incidence of annual progression was significantly lower in non-dyspnea than in dyspnea group (17% vs. 53%, adjusted p = 0.026). The relative change in DLCO was significantly slower in non-dyspnea group (adjusted p = 0.036), but FVC was not (adjusted p = 0.067). Overall survival was longer in non-dyspnea group (adjusted p = 0.0089). The discontinuation rate and therapeutic period of nintedanib were not significantly different between the groups. Conclusions: Asymptomatic patients with FILD have severe exercise-induced oxygen desaturation and better outcomes after nintedanib therapy than symptomatic patients. Antifibrotic drug therapy should not be avoided solely because of a lack of symptoms.

The prognostic role of high-density lipoprotein cholesterol/C-reactive protein ratio in idiopathic pulmonary fibrosis

BACKGROUND

The prognosis of idiopathic pulmonary fibrosis (IPF) patients is highly heterogeneous. Abnormalities in lipids and their metabolism play an important role in the development of IPF.

AIM

To investigate the value of lipid parameters, C-reactive protein (CRP) and high-density lipoprotein cholesterol/C-reactive protein (HDL-C/CRP) ratio levels in the prognosis of IPF patients.

DESIGN

An observational cohort study.

METHODS

We collected baseline data of non-IPF controls and IPF patients, and IPF patients were followed up for 4 years. All-cause death or lung transplantation and IPF-related death were the outcome events. Receiver operating characteristic curves and Cox proportional hazards models were used to analyze the predictive effect of lipid parameters, CRP and HDL-C/CRP ratio on the prognosis of IPF patients.

RESULTS

IPF patients had lower HDL-C, HDL-C/CRP ratio and higher CRP compared to non-IPF controls. IPF patients who died or underwent lung transplantation were older and had worse pulmonary function, lower HDL-C, HDL-C/CRP ratio and higher CRP compared with surviving patients. HDL-C/CRP ratio was better than HDL-C and CRP in predicting all-cause death or lung transplantation. IPF patients with low HDL-C/CRP ratio had shorter survival times. The HDL-C/CRP ratio and diffusing capacity for carbon monoxide(DLCO)% of predicted were independent protective factors for all-cause death or lung transplantation and IPF-related death in IPF patients, while age and gender-age-physiology (GAP) Stage ≥ 2 (HR = 4.927) were independent risk factors for all-cause death or lung transplantation. Age > 65 years (HR = 3.533) was an independent risk factor for IPF-related death.

CONCLUSION

HDL-C/CRP ratio was a valid predictor of clinical outcomes in IPF patients, including all-cause death or lung transplantation and IPF-related death.

Development of a multivariable prediction model for progression of systemic sclerosis-associated interstitial lung disease

OBJECTIVE

To develop a multivariable model for predicting the progression of systemic sclerosis-associated interstitial lung disease (SSc-ILD) over 52 weeks.

METHODS

We used logistic regression models to analyse associations between candidate predictors assessed at baseline and progression of SSc-ILD (absolute decline in forced vital capacity (FVC) % predicted >5% or death) over 52 weeks in the placebo group of the SENSCIS trial. Analyses were performed in the overall placebo group and in a subgroup with early and/or inflammatory SSc and/or severe skin fibrosis (<18 months since first non-Raynaud symptom, elevated inflammatory markers, and/or modified Rodnan skin score (mRSS) >18) at baseline. Model performance was assessed using the area under the receiver operating characteristic curve (AUC).

RESULTS

In the overall placebo group (n=288), the performance of the final multivariable model for predicting SSc-ILD progression was moderate (apparent AUC: 0.63). A stronger model, with an apparent AUC of 0.75, was developed in the subgroup with early and/or inflammatory SSc and/or severe skin fibrosis at baseline (n=155). This model included diffusing capacity of the lung for carbon monoxide (DLco) % predicted, time since first non-Raynaud symptom, mRSS, anti-topoisomerase I antibody status and mycophenolate use.

CONCLUSION

Prediction of the progression of SSc-ILD may require different approaches in distinct subgroups of patients. Among patients with SSc-ILD and early and/or inflammatory SSc and/or severe skin fibrosis, a nomogram based on a multivariable model may be of value for identifying patients at risk of short-term progression.

Value of bronchoalveolar lavage fluid metagenomic next-generation sequencing in acute exacerbation of fibrosing interstitial lung disease: an individualized treatment protocol based on microbiological evidence

BACKGROUND

Acute exacerbation of fibrosing interstitial lung diseases (AE-ILD) is a serious life-threatening event per year. Methylprednisolone and/or immunosuppressive agents (ISA) are a mainstay in any regimen, under the premise that pulmonary infection has been promptly identified and controlled. We investigated the value of bronchoalveolar lavage fluid (BALF) metagenomic next-generation sequencing (mNGS) on the treatment adjustment of AE-ILD.

METHODS

We conducted a cross-sectional observational study. All data were collected prospectively and retrospectively analyzed. We included fifty-six patients with AE-ILD and nineteen stable ILD who underwent BALF mNGS at the beginning of admission.

RESULTS

Patients with a variety of ILD classification were included. Connective-tissue disease related ILD (CTD-ILD) occupy the most common underlying non-idiopathic pulmonary fibrosis (non-IPF). The infection-triggered AE accounted for 39.29%, with the majority of cases being mixed infections. The microorganisms load in the AE-ILD group was significantly higher. After adjusted by mNGS, the therapy coverage number of pathogens was significantly higher compared to the initial treatment (p < 0.001). After treatment, the GGO score and the consolidation score were significantly lower during follow up in survivors (1.57 ± 0.53 vs. 2.38 ± 0.83 with p < 0.001, 1.11 ± 0.24 vs. 1.49 ± 0.47 with p < 0.001, respectively). Some detected microorganisms, such as Tropheryma whipplei, Mycobacterium, Aspergillus, and mixed infections were difficult to be fully covered by empirical medication. BALF mNGS was also very helpful for excluding infections and early administration of methylprednisolone and/or ISA.

CONCLUSIONS

mNGS has been shown to be a useful tool to determine pathogens in patients with AE-ILD, the results should be fully analyzed. The comprehensive treatment protocol based on mNGS has been shown crucial in AE-ILD patients.

Biomarkers in the evaluation of cardiac involvement in systemic sclerosis

Systemic sclerosis is a multisystemic disease for which the heart can be affected leading to cardiac complications and mortality. Up to 80% of patients with systemic sclerosis have cardiac involvement with varying levels of severity. Several molecules have been identified that can be used as markers of cardiac involvement. These biomarkers can arise directly from the heart due to cardiac damage from the disease such as cardiac troponins or from the underlying dysregulated immune process itself such as the proinflammatory cytokines including interleukin (IL)-6. This review aims to summarize the evidence on currently known biomarkers that are can be diagnostic, prognostic or predictive of primary cardiac involvement in systemic sclerosis. We also highlight potential new biomarkers based on the current understanding of the disease process. Clinical use of these markers can benefit patients through earlier identification of those with cardiac involvement, many of whom can be asymptomatic in the early stage, with higher risk of complications, with the overall goal to improve outcomes of these affected patients.

C-reactive protein as a candidate biomarker in fibrotic interstitial lung disease

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