Figures
- FIGURE 1
Inclusion and exclusion flow diagram. PCP: Pneumocystis pneumonia; GMS: Gomori methenamine silver; ILD: interstitial lung disease.
- FIGURE 2
Kaplan–Meier comparison of survival curves between the interstitial lung disease (ILD) and non-ILD groups. The 90-day mortality was significantly higher in the ILD group than in the non-ILD group (62.5% versus 19.0%). PCP: Pneumocystis pneumonia.
- FIGURE 3
Kaplan–Meier comparison of survival curves between lower and higher percentage of bronchoalveolar lavage fluid (BALF) neutrophil groups. The patients were categorised into the “higher” or “lower” group according to the median percentage of BALF neutrophils. a) With regards to all subjects as a whole, the 90-day survival was significantly worse in the higher group (n=28) than in the lower group (n=23) (90-day mortality rate in the higher group: 50.0%; lower group: 17.4%). b) In the interstitial lung disease (ILD) group, the 90-day survival was significantly worse in the higher group (n=12) than in the lower group (n=10) (higher group: 90.0%; lower group: 50.0%). c) In the non-ILD group, the 90-day survival was not different between the higher group (n=14) and the lower group (n=15) (higher group: 13.3%; lower group: 7.1%).
- FIGURE 4
Comparisons of serum levels of β-d-glucan and Krebs von den Lungen-6 (KL-6) before and after Pneumocystis pneumonia treatment. The levels of β-d-glucan significantly decreased in both groups: a) median value of the interstitial lung disease (ILD) group from 78.5 to 38.5 pg·mL−1, p=0.006; b) non-ILD group from 95.0 to 27.0 pg·mL−1, p=0.001). c) The level of KL-6 significantly increased in the ILD group (median value from 1505.0 to 2730.0 U·mL−1, p=0.001) and d) did not change significantly in the non-ILD group (median value from 659.5 to 550.0 U·mL−1, p=0.249).
- FIGURE 5
Kaplan–Meier comparison of survival curves in the interstitial lung disease patients divided by increasing or decreasing Krebs von den Lungen-6 (KL-6) levels after Pneumocystis pneumonia (PCP) treatment. The 90-day mortality of the patients with increasing KL-6 after the treatment was significantly higher than those with decreasing KL-6 (increasing KL-6, n=19: 78.9%; decreasing KL-6, n=5: 0%).
Tables
- TABLE 1
Patient characteristics
All ILD group non-ILD group p-value Subjects 74 32 42 Age years 73.5 (66.0–80.0) 74.0 (68.5–80.8) 68.0 (66.5–73.0) 0.125 Male sex 40 (83.3%) 22 (68.8%) 27 (64.3%) 0.805 Ever-smokers 46 (62.2%) 20 (62.5%) 26 (61.9%) 1.000 BMI kg·m−2 21.8 (19.5–24.0) 22.4 (19.1–24.0) 21.0 (19.8–24.0) 0.291 Previous use of corticosteroids 69 (93.2%) 31 (96.9%) 38 (90.5%) 0.381 Previous use of immunosuppressants 27 (36.5%) 10 (31.3%) 17 (40.5%) 0.471 PCP prophylaxis 1 (1.4%) 0 (0.0%) 1 (2.4%) 1.000 Underlying diseases IIPs 9 (12.2%) 9 (28.1%) 0 (0.0%) <0.001 CTD 24 (32.4%) 11 (34.4%) 13 (31.0%) 0.806 Solid tumour 20 (27.0%) 5 (15.6%) 15 (35.7%) 0.067 Haematologic malignancy 8 (10.8%) 2 (6.3%) 6 (14.3%) 0.453 Others 13 (17.6%) 5 (15.6%) 8 (19.0%) 0.331 Diagnostic procedures of PCP BALF GMS stain 19 (25.7%) 11 (34.4%) 8 (19.0%) 0.181 BALF PCR 38 (51.4%) 15 (46.9%) 23 (54.8%) 0.639 Sputum PCR 23 (31.1%) 9 (28.1%) 14 (33.3%) 0.800 Laboratory findings Lymphocyte count cells per µL 695.0 (346.0–1067.5) 648.0 (326.0–980.0) 695.0 (367.0–1100.0) 0.688 Albumin mg·dL−1 2.7 (2.3–3.1) 2.6 (2.4–2.9) 2.8 (2.2–3.4) 0.271 LDH U·L−1 434.0 (295.0–540.5) 434.0 (298.0–544.0) 453.0 (293.0–544.0) 0.819 KL-6# U·mL−1 754.0 (476.0–1705.0) 1170.0 (703.0–2271.8) 585.5 (411.5–965.8) 0.001 CRP mg·dL−1 6.7 (3.3–11.5) 4.8 (2.1–10.9) 6.9 (5.0–14.0) 0.230 eGFR mL·min−1·1.73 m−2 60.2 (42.3–81.5) 58.0 (43.0–69.9) 64.7 (41.8–85.1) 0.285 β-d-glucan pg·mL−1 87.0 (66.0–80.0) 78.4 (28.5–281.8) 86.7 (46.8–240.0) 0.382 PaO2/FIO2 ratio 248.0 (155.8–298.0) 175.0 (107.0–289.5) 251.5 (180.0–301.0) 0.025 BALF findings¶ Neutrophils 12.2% (4.9–40.5%) 22.6% (10.6–47.9%) 6.6% (3.2–38.1%) 0.012 Lymphocytes 34.3% (11.3–55.3%) 30.0% (9.5–48.0%) 46.0% (8.75–64.9%) 0.101 Eosinophils 1.0% (0.0–2.3%) 0.2% (0.0–2.0%) 1.0% (0.0–3.0%) 0.69 Macrophages 34.0% (18.0–49.0%) 37.5% (22.3–54.8%) 33.0% (18.0–49.0%) 0.312 Data are presented as median (interquartile range) unless otherwise stated. ILD: interstitial lung disease; BMI: body mass index; PCP: Pneumocystis pneumonia; IIP: idiopathic interstitial pneumonia; CTD: connective tissue disease; BALF: bronchoalveolar lavage fluid; GMS: Gomori methenamine silver; LDH: lactate dehydrogenase; KL-6: Krebs von den Lungen-6; CRP: C-reactive protein; eGFR: estimated glomerular filtration rate; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction. #: n=69; ¶: n=53. The p-values refer to comparisons between the ILD and non-ILD groups.
- TABLE 2
Clinical diagnosis and high-resolution computed tomography (HRCT) patterns of interstitial lung disease (ILD)
Patients# Clinical diagnosis of ILD IIPs 17 (53.1%) IPF 8 (25.0%) Non-IPF 9 (28.1%) Non-IIPs 15 (46.9%) CTD-ILD 11 (34.4%) CHP 1 (3.1%) CEP 1 (3.1%) Asbestosis 1 (3.1%) Radiation pneumonitis 1 (3.1%) HRCT patterns of ILD UIP pattern 11 (34.4%) Non-UIP pattern 21 (65.6%) IIP: idiopathic interstitial pneumonia; IPF: idiopathic pulmonary fibrosis; CTD: connective tissue disease; CHP: chronic hypersensitivity pneumonia; CEP: chronic eosinophilic pneumonia; UIP: usual interstitial pneumonia. #: n=32.
- TABLE 3
Univariate and multivariate analyses of predictors of 90-day mortality
Variables HR (95% CI) p-value Univariate analysis Pre-existing ILD 4.003 (1.761–9.098) 0.001 Steroid pulse therapy 3.135 (1.488–6.606) 0.004 Albumin 0.364 (0.214–0.621) <0.001 KL-6 1.000 (1.000–1.001) 0.002 LDH 1.002 (1.000–1.003) 0.074 CRP 1.045 (0.992–1.101) 0.095 PaO2/FIO2 ratio 0.991 (0.987–0.996) <0.001 Multivariate analysis Pre-existing ILD 5.952 (1.900–18.649) 0.002 Albumin 0.312 (0.131–0.743) 0.009 HR: hazard ratio; ILD: interstitial lung disease; KL-6: Krebs von den Lungen-6; LDH: lactate dehydrogenase; CRP: C-reactive protein; PaO2: arterial oxygen tension; FIO2: inspiratory oxygen fraction.
Supplementary Material
Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.
Table S1 00306-2019.SUPPLEMENT
Figure S1 00306-2019.figureS1
Figure S2 00306-2019.figureS2
