OP0063 QUANTITATIVE COMPUTED TOMOGRAPHY PREDICTS 10-YEAR MORTALITY IN INTERSTITIAL LUNG DISEASE RELATED TO SYSTEMIC SCLEROSIS

Background:

Interstitial lung disease (ILD) is the main cause of death in Systemic Sclerosis (SSc). Chest CT is the gold standard in detecting ILD although it is not easy to understand its prognostic value. ILD qualitative assessment is almost worthless. Goh et al. semi quantitative score of ILD extent is related to mortality risk but it is burdened by relevant inter/intra-readers variability. An operator independent algorithm based on voxel-wise analysis proved to identify SSc patients with an increased risk of mortality according to prediction models.

Objectives:

To verify if quantitative analysis of chest CT (QCT) predict 10 years-mortality in SSc patients.

Methods:

SSc patients with availability of a chest CT were enrolled in 13 different centers. The CT voxel-wise analysis with a free software (www.horosproject.com) provided QCT indexes: kurtosis, skewness, mean lung attenuation and standard deviation. Patients characteristics, autoimmune profile and pulmonary function test were collected. The follow-up interval lasted from the date of chest CT to the one of the last visit or death. Each QCT index cutoff, established in a previous study (1), clustered patients in two groups. Kaplan-Meier analysis estimated and compared survival in the above mentioned groups. p < 0.05 was considered statistically significant.

Results:

Five hundred sixty three SSc patients were enrolled (35938 patient-months); 52.4% had ILD detectable at CT scan. For each QCT index cutoff the cohort was split in two subgroups without differences in terms of sex, age, disease duration, autoimmune profile. All QCT indexes’ cutoff selected subgroups with statistically different survival rate (e.g in Figure 1).

Figure 1

Conclusion:

QCT can arise as the new gold standard in identifying SSc patients with poor prognosis. The real possibility to stratify SSc subjects according mortality risk will have a pivotal role in ILD treatment decisional process with the incoming anti-fibrotic drugs.

References:

[1]Ariani A et al. Rheumatology 2017

Disclosure of Interests:

Alarico Ariani: None declared, Elena Bravi: None declared, Maria De Santis: None declared, Vanessa Hax: None declared, Simone Parisi: None declared, Federica Lumetti: None declared, Francesco Girelli: None declared, Marta Saracco: None declared, Fabio De Gennaro: None declared, Alessandro Giollo: None declared, Masen Abdel Jaber: None declared, Francesco Bozzao: None declared, Mario Silva: None declared, Maria Chiara Ditto: None declared, Claudia Lomater: None declared, Flavio Mozzani: None declared, Daniele Santilli: None declared, eleonora Di Donato: None declared, Andrea Becciolini Speakers bureau: Sanofi-Genzyme, UCB and AbbVie, Francesco Pucciarini: None declared, Lorenzo Canziani: None declared, Flavio Cesare Bodini: None declared, eugenio arrigoni: None declared, M Bredemeier: None declared, Rafael Mendonça da Silva Chakr: None declared, Amelia Spinella: None declared, Luca Idolazzi: None declared, Roberto Bortolotti: None declared, Paola Tomietto: None declared, Elisa Baratella: None declared, Saverio Tollot: None declared, Dilia Giuggioli: None declared, Fabio Fischetti: None declared, Enrico Fusaro: None declared, Nicola Sverzellati: None declared, Carlo Alberto Scirè: None declared

[Therapy of chronic hepatitis C with alpha-interferon in 182 patients. Evaluation of results, response predictive factors and side effects]

BACKGROUND

The aim of this study was to assess the results, predictors of response and side effects of therapy with alpha-interferon (IFN) in chronic C virus (HCV) infection.

METHODS

A group of 182 patients (150 chronic hepatitis and 32 cirrhosis) was treated with alpha-interferon--recombinant IFN in 120 cases (66%), and lymphoblastoid IFN in 62 cases (34%)--at a dosage of 3 MU three times weekly for 12 months. All our patients were prospectively followed for at least 6 months, and 133 patients for more than 2 years.

RESULTS

A short-term positive response was achieved in 65% of our patients, a sustained response in 34%, and a long-term response in 35%, the responses being similar both for hepatitis and cirrhosis. Liver histology, after 2 years, improved in 73% of long-term responders, whereas it improved only in 34% of relapsers. The predictors of response were: age, duration of disease, baseline levels of gamma-glutamyltranspeptidase (GGT) and serum ferritin. Both types of IFN proved to have the same efficacy. Side effects were observed in 52% of our patients, which were correlated with age and female sex.

CONCLUSIONS

Interferon therapy yields good results, if administered for 12 months, in young patients with disease of short duration and low baseline levels of GGT and serum ferritin, even in the presence of cirrhosis, if at early-stage. Patients with normal alanine aminotransferase (ALT) levels after 3 years may be considered fully recovered. The dosage employed was well tolerated.

[Spontaneous bacterial peritonitis (SBP): prevalence and characteristics in a population of 314 cirrhotic patients evaluated at hospital admission]

BACKGROUND

The aim of this study was to evaluate the incidence and the characteristics of the infections of ascitic fluid in cirrhotic patients at the moment of hospital admission.

METHODS

A total of 314 patients consecutively submitted to ascitic fluid tap within 3 days of hospital admission were studied. Each patient was classified according to Child-Plugh classes. Neoplastic ascites were excluded. The ascitic fluid was analyzed for PMN count, protein and albumin content, cultural and cytological examinations. The patients with ascitic fluid PMN > 250/ml were immediately treated with antibiotics.

RESULTS

Out of 314 patients 11% had SBP (94% in class C patients according to Child-Plugh classification), 17% CNNA and 3% MNNB. 15% of SBP patients were asymptomatic. Total protein content in ascitic fluid was significantly lower in SBP and MNNB compared to CNNA and sterile ascites. 56% of the isolated bacteria was Gram-negative, and the most frequently found were Streptococcus, Escherichia coli and Staphylococcus. 80% of the patients with ascites infection underwent third generation cephalosporin treatment. SBP mortality (29%) was significantly higher than CNNA (9%), MNNB (10%) and sterile ascites (11%), also taking into account the subgroup without ascites infection and class C group (14%).

CONCLUSIONS

In view of the high incidence (even in the absence of invasive procedures), of the possibility of symptom free patients and of the high mortality of SBP, it is advisable to carry out routine tap in all cirrhotics with ascites at hospital admission.

Prevalence of anticardiolipin antibodies in juvenile chronic arthritis

The prevalence of anticardiolipin antibodies was evaluated in 70 children with juvenile chronic arthritis (JCA), in 25 adult patients with rheumatoid arthritis, in 42 healthy children and in 40 adult controls. Thirty seven (53%) patients with JCA were positive for IgG or IgM anticardiolipin antibodies, or both, and 30 (43%) for IgG anticardiolipin antibodies. In contrast, only seven (28%) adult patients with rheumatoid arthritis presented anticardiolipin antibodies, which were of IgG class in four (16%) cases. IgG anticardiolipin antibodies were negative in all control subjects while IgM anticardiolipin antibodies were detected in two (5%) children and in four (10%) adult controls. No correlations were found in patients with JCA between the presence or titres of anticardiolipin antibodies and various clinical or laboratory variables. No patient with anticardiolipin antibodies showed any feature of the anticardiolipin syndrome.

Autoantibodies in juvenile dermatomyositis

Fourteen patients with juvenile dermatomyositis (JDM) have been investigated for the presence of several serum autoantibodies: antinuclear (ANA), anti-single-stranded and double-stranded DNA, anti-histones, anti-Sm, anti-ribonucleoprotein, anti-SSA/SSB, anti-PM-1, anti-Jo-1, anti-mitochondrial, anti-smooth muscle, anti-gastric parietal cells, anti-cardiolipin (ACA) antibodies and rheumatoid factor. Patients were negative for all autoantibodies except for ANA and ACA. ANA were detected in 50% of the patients when tested on rat liver, but the percentage of positivity rose to 86% when HEp-2 cells were used as substrate. This finding suggests that HEp-2 cells represent a more sensitive substrate than rat liver for the detection of ANA in JDM. Three patients were positive for ACA; two of these presented vascular complications, thus suggesting a possible relationship between ACA and vascular involvement in JDM.

Hematological abnormalities associated with anticardiolipin antibodies

Information about anticardiolipin antibodies in different autoimmune diseases has increased rapidly in the last few years. Clinical and laboratory associations with hematologic disturbances such as recurrent thromboses, lupus anticoagulant, autoimmune thrombocytopenia and positive Coombs' test have been reported in many studies. The present paper deals with a short review on the actual clinical significance of detection and measurement of anticardiolipin antibodies, as well as their putative role in different blood disorders.

Anti-phospholipid antibodies and thrombotic thrombocytopenic purpura

Anti-phospholipid antibodies were measured in 9 patients with active thrombotic thrombocytopenic purpura (TTP). 8 patients had primary TTP and one had TTP secondary to systemic lupus erythematosus (SLE). No patient showed circulating 'lupus' anticoagulants or false positive tests for syphilis. A solid phase immuno-assay for anti-cardiolipin antibodies (ACA) gave negative results in the patient with secondary TTP as well as in all but one case with primary TTP. ACA of IgG class were not found in any TTP patient while they were present in 10 out of 18 patients suffering from thrombocytopenia with active SLE. These data indicate that anti-phospholipid antibodies do not have a role in the development of thrombosis and thrombocytopenia with TTP.