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Engelbrecht E, Kooistra T, Knipe RS. The Vasculature in Pulmonary Fibrosis. CURRENT TISSUE MICROENVIRONMENT REPORTS 2022; 3:83-97. [PMID: 36712832 PMCID: PMC9881604 DOI: 10.1007/s43152-022-00040-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 02/02/2023]
Abstract
Purpose of Review The current paradigm of idiopathic pulmonary fibrosis (IPF) pathogenesis involves recurrent injury to a sensitive alveolar epithelium followed by impaired repair responses marked by fibroblast activation and deposition of extracellular matrix. Multiple cell types are involved in this response with potential roles suggested by advances in single-cell RNA sequencing and lung developmental biology. Notably, recent work has better characterized the cell types present in the pulmonary endothelium and identified vascular changes in patients with IPF. Recent Findings Lung tissue from patients with IPF has been examined at single-cell resolution, revealing reductions in lung capillary cells and expansion of a population of vascular cells expressing markers associated with bronchial endothelium. In addition, pre-clinical models have demonstrated a fundamental role for aging and vascular permeability in the development of pulmonary fibrosis. Summary Mounting evidence suggests that the endothelium undergoes changes in the context of fibrosis, and these changes may contribute to the development and/or progression of pulmonary fibrosis. Additional studies will be needed to further define the functional role of these vascular changes.
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Affiliation(s)
| | - Tristan Kooistra
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Rachel S. Knipe
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Kaya AT, Akman B. Mediastinal lymph node enlargement in COVID-19: Relationships with mortality and CT findings. Heart Lung 2022; 54:19-26. [PMID: 35306375 PMCID: PMC8907027 DOI: 10.1016/j.hrtlng.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presence of mediastinal lymph node enlargement (MLNE) in computed tomography (CT) of Coronavirus disease 2019 (COVID-19) patients can be associated with disease severity. OBJECTIVES To investigate the relationship between MLNE with intensive care unit admission (ICU), mortality rates, and CT findings, especially in early-stage COVID-19 patients. METHODS This single-center retrospective case-control study, included aged ≥18 years, 250 COVID-19 patients with positive RT-PCR tests. We included two patient groups, 125/250 with and without MLNE. Demographic information of the patients, laboratory findings, length of stay in hospital or ICU, mortality rates, initial CT imaging findings and CT severity scores (CT-SS) were recorded and their relationship with MLNE was investigated. RESULTS Patients with MLNE were older (69.61 ± 11.16; p < 0.001) and had a higher CT-SS (14.67 ± 7.55; p < 0.001). There was a significant difference between the presence of MLNE with mortality (58/77, 75.3%; p < 0.001) and ICU admission (49/61, 80.3%; p < 0.001). Also, a statistical association was found between MLNE with ICU admission (p = 0.001) and (p < 0.001) mortality rates in patients with CORADS≤2 CT findings. In multivariate logistic regression analysis, MLNE was 8.8-fold (95% CI: 1.62-47.86, p = 0.01) more correlated with linear opacity and 0.25-fold with bronchial wall thickening (95% CI: 0.07-0.92, p = 0.04). CONCLUSION Mediastinal lymph node enlargement is an important CT finding that can predict the severe prognosis of COVID-19 patients. Even in patients without lung involvement on initial CT, the presence of MLNE should be carefully examined as it is associated with disease severity.
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Affiliation(s)
- Ahmet Turan Kaya
- Department of Radiology, Faculty of Medicine, Amasya University, Sabuncuoğlu Şerefeddin Research and Education Hospital, Amasya, Turkey.
| | - Burcu Akman
- Department of Radiology, Faculty of Medicine, Amasya University, Sabuncuoğlu Şerefeddin Research and Education Hospital, Amasya, Turkey
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Wallis TJM, Gudmundsson E, Pontoppidan K, Mogulkoc N, Savaş R, Unat ÖS, Vedwan K, Battison S, Thompson FJ, Brereton CJ, Marshall BG, Fletcher SV, Richeldi L, Jacob J, Jones MG. Temporal progression of mediastinal lymphadenopathy in idiopathic pulmonary fibrosis. Eur Respir J 2022; 59:2200024. [PMID: 35115340 PMCID: PMC7615162 DOI: 10.1183/13993003.00024-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/16/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Tim J M Wallis
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Katarina Pontoppidan
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Nesrin Mogulkoc
- Dept of Respiratory Medicine, Ege University Hospital, Izmir, Turkey
| | - Recep Savaş
- Dept of Radiology, Ege University Hospital, Izmir, Turkey
| | - Ömer Selim Unat
- Dept of Respiratory Medicine, Ege University Hospital, Izmir, Turkey
| | - Katharine Vedwan
- Dept of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
| | - Sobana Battison
- Dept of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
| | - Fiona J Thompson
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
| | - Christopher J Brereton
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ben G Marshall
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Sophie V Fletcher
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Luca Richeldi
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- Unità Operativa Complessa di Pneumologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, UK
- UCL Respiratory, University College London, London, UK
| | - Mark G Jones
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, UK
- School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Usefulness of Body Composition CT Analysis in Patients with Idiopathic Pulmonary Fibrosis: A Pilot Study. Acad Radiol 2022; 29 Suppl 2:S191-S201. [PMID: 34417107 DOI: 10.1016/j.acra.2021.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the feasibility of a chest CT-based body composition analysis in idiopathic pulmonary fibrosis (IPF), and to investigate the respective contribution of lung and muscle CT quantitative analyses to the prognosis of IPF. METHOD A total of 71 IPF patients were recruited at diagnosis. All patients underwent a standard chest CT-scan and a bioelectrical impedance analysis considered as reference standard for estimating malnutrition through the use of the fat-free mass index (FFMI). The skeletal muscle index (SMI) was measured on chest-CT at the level of the first lumbar vertebra by two radiologists. Lung fibrosis extent was quantified by three radiologists in consensus. The extent of emphysema, the pulmonary artery to aorta (PA/AO) diameter ratio and lymph node enlargement were also reported. Mortality and hospitalization over a 14-month follow-up were recorded. RESULTS A low FFMI defining malnutrition was identified in 26.8% of patients. SMI was significantly lower in these patients (p<0.001) and was correlated with FFMI (r=0.637, p<0.001). Interobserver agreement of SMI measurement was very good (ICC=0.91). For diagnosing malnutrition, SMI showed a 0.79 sensitivity, a 0.69 specificity, a 0.48 PPV and a 0.90 NPV. In univariate analysis, fibrosis extent was significantly associated with death, while SMI did not reach significance. In multivariate analysis, fibrosis extent and PA/AO ratio were independently associated with hospitalization. CONCLUSIONS SMI measured on chest CT could be a reliable tool to exclude malnutrition in IPF. A quantitative analysis of both fibrosis and skeletal muscle may allow holistic management of IPF patients.
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Satici C, Cengel F, Gurkan O, Demirkol MA, Altunok ES, Esatoglu SN. Mediastinal lymphadenopathy may predict 30-day mortality in patients with COVID-19. Clin Imaging 2021; 75:119-124. [PMID: 33545439 PMCID: PMC8064813 DOI: 10.1016/j.clinimag.2021.01.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 12/27/2020] [Accepted: 01/27/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE There is scarce data on the impact of the presence of mediastinal lymphadenopathy on the prognosis of coronavirus-disease 2019 (COVID-19). We aimed to investigate whether its presence is associated with increased risk for 30-day mortality in a large group of patients with COVID-19. METHOD In this retrospective cross-sectional study, 650 adult laboratory-confirmed hospitalized COVID-19 patients were included. Patients with comorbidities that may cause enlarged mediastinal lymphadenopathy were excluded. Demographics, clinical characteristics, vital and laboratory findings, and outcome were obtained from electronic medical records. Computed tomography scans were evaluated by two blinded radiologists. Univariate and multivariate logistic regression analyses were performed to determine independent predictive factors of 30-day mortality. RESULTS Patients with enlarged mediastinal lymphadenopathy (n = 60, 9.2%) were older and more likely to have at least one comorbidity than patients without enlarged mediastinal lymphadenopathy (p = 0.03, p = 0.003). There were more deaths in patients with enlarged mediastinal lymphadenopathy than in those without (11/60 vs 45/590, p = 0.01). Older age (OR:3.74, 95% CI: 2.06-6.79; p < 0.001), presence of consolidation pattern (OR:1.93, 95% CI: 1.09-3.40; p = 0.02) and enlarged mediastinal lymphadenopathy (OR:2.38, 95% CI:1.13-4.98; p = 0.02) were independently associated with 30-day mortality. CONCLUSION In this large group of hospitalized patients with COVID-19, we found that in addition to older age and consolidation pattern on CT scan, enlarged mediastinal lymphadenopathy were independently associated with increased mortality. Mediastinal evaluation should be performed in all patients with COVID-19.
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Affiliation(s)
- Celal Satici
- Department of Chest Diseases, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Ferhat Cengel
- Department of Radiology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Okan Gurkan
- Department of Radiology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Asim Demirkol
- Department of Chest Diseases, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif Sargin Altunok
- Department of Infectious Disease and Clinical Microbiology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Department of Rheumatology, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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González FJ, Alvarez A, Cantador B, Moreno P, Baamonde C, Muñoz A, Poveda D, Algar FJ, Cerezo F, Salvatierra A. Relationship Among Radiological Measurements of Anterior Mediastinal Fat and Outcomes of Lung Transplantation in Fibrotic Patients. Arch Bronconeumol 2020; 56:710-717. [DOI: 10.1016/j.arbres.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 01/10/2023]
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Sgalla G, Larici AR, Golfi N, Calvello M, Farchione A, Del Ciello A, Varone F, Iovene B, Manfredi R, Richeldi L. Mediastinal lymph node enlargement in idiopathic pulmonary fibrosis: relationships with disease progression and pulmonary function trends. BMC Pulm Med 2020; 20:249. [PMID: 32957969 PMCID: PMC7507660 DOI: 10.1186/s12890-020-01289-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence of mediastinal Lymph Node Enlargement (LNE) on CT scan is a common finding in idiopathic pulmonary fibrosis (IPF). We sought to investigate whether the involvement of mediastinal lymph nodes is associated with accelerated disease progression, and explored the changes occurring in mediastinal lymph nodes during the radiological follow up of these patients. METHODS This retrospective study included IPF patients referred to a single ILD centre in Italy. A consensus-based assessment of mediastinal LNE on chest CT scan was performed by two thoracic radiologists. Kaplan-Meier curves and multivariate Cox proportional hazards regression were used to assess hazard ratios for mortality and disease progression (defined as categorical FVC decline ≥10%). The annualized rates of change in functional parameters for each patient were calculated using mixed linear models. RESULTS The study population consisted of 152 IPF patients, of whom 135 (89%) received antifibrotic treatment for IPF during the study follow up. Patients having evidence of 3 or more enlarged mediastinal lymph nodes on baseline CT scan showed increased rates of mortality (HR 5.03, 95% CI 1.86-13.62, p ≤ 0.001) and significant disease progression (HR 2.99, 95% CI 1.22-7.33, p = 0.17) as compared to patients without LNE, after adjusting for GAP stage. Among 62 patients with LNE who underwent a follow up CT scan of the chest and received antifibrotic treatment, 57 (92%) maintained evidence mediastinal LNE over time. CONCLUSIONS Diffuse mediastinal lymph node involvement predicts clinically meaningful functional deterioration in patients with IPF.
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Affiliation(s)
- Giacomo Sgalla
- Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy.
| | - Anna Rita Larici
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario Scienze Radiologiche ed Ematologiche, Sezione di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicoletta Golfi
- Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Mariarosaria Calvello
- Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessandra Farchione
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Annemilia Del Ciello
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Varone
- Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Bruno Iovene
- Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario Scienze Radiologiche ed Ematologiche, Sezione di Radiologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Richeldi
- Dipartimento Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Moua T, Lee AS, Ryu JH. Comparing effectiveness of prognostic tests in idiopathic pulmonary fibrosis. Expert Rev Respir Med 2019; 13:993-1004. [PMID: 31405303 DOI: 10.1080/17476348.2019.1656069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Idiopathic pulmonary fibrosis (IPF) is a debilitating and progressive fibrotic interstitial lung disease often resulting in death over several years. Prediction of disease course or survival remains of keen interest for clinicians and patients though a commonly used test or tool remain elusive. Areas covered: We undertook a comprehensive review of the published literature highlighting prognostic indicators and predictors of survival in IPF. Baseline and longitudinal clinical, functional, histopathologic, and radiologic findings have been extensively studied as prognostic predictors, both individually and in composite models. Recent approaches include automated quantifiable radiologic scoring, circulating biomarkers, and genetic polymorphisms or abnormalities. This review highlights individual and composite predictors and their relative utility in clinical practice and research studies. Expert opinion: There is a growing body of knowledge highlighting readily available individual and composite predictors of outcome, though none have come to the forefront for common clinical use. Recent advances include quantitative imaging analysis, circulating serologic markers, and genetic testing, which may be more standardized and less prone to lead-time bias or related complications and comorbidities.
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Affiliation(s)
- Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester , MN , USA
| | - Augustine S Lee
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Jacksonville , FL , USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic , Rochester , MN , USA
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