Impact of computed tomographic patterns and extent on clinical management and outcomes of patients with organizing pneumonia
- Tang-Hsiu Huang1,2,8,
- Sheng-Huan Wei1,8,
- Li-Ting Huang3,
- Hong-Ping Er1,4,
- Yu-Ting Yu5,
- Chung-Ta Lee5,
- Yau-Lin Tseng6 and
- Chao-Liang Wu2,7⇑
- 1Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University, College of Medicine and Hospital, Tainan, Taiwan
- 2Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 3Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 4Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
- 5Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 6Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 7Department of Biochemistry and Molecular Biology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 8These two authors contributed equally to this manuscript
- Corresponding author: Chao-Liang Wu (wumolbio{at}mail.ncku.edu.tw)
Abstract
Background Organizing pneumonia (OP) has variable clinical and radiographic presentations and unstandardized treatments. Most patients with OP have favourable outcomes, but some develop respiratory insufficiency, experience recurrence, or die. In this study we investigated the impact of computed tomographic (CT) patterns and extent of OP on the diagnostic and therapeutic management that patients received, and that on the therapeutic response and prognosis (particularly the risk of respiratory insufficiency and death).
Methods We retrospectively studied 156 patients with OP followed at our hospital between 2010 and 2021. The diagnosis was confirmed histologically and verified by multidisciplinary specialists. We performed Firth's logistic regression to determine the relationship between CT features and aetiologies, management, and outcomes including the risk of severe disease (defined as the need of supplemental oxygen or mechanical ventilation). We conducted Kaplan-Meier analyses to assess survival differences.
Results Patients exhibiting multi-lobe involvement or mixed patterns, or both, were more likely to have secondary OP and receive immunosuppressants. Higher proportions of these patients experienced recurrence. Compared to patients with single-lobe involvement and single-pattern, they also had an enhanced risk of severe disease (the adjusted odds ratio for patients who simultaneously had multi-lobe involvement and mixed patterns was 27.64; 95% confidence interval, 8.25–127.44). Besides, these patients had decreased survival probabilities.
Conclusion Different CT features of OP impact patients’ management and prognosis. When treating patients with OP exhibiting multi-lobe involvement or mixed patterns, or both, it is important to identify the possible causative aetiology and follow closely for adverse outcomes.
Footnotes
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- Received September 28, 2022.
- Accepted November 1, 2022.
- Copyright ©The authors 2022
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