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Meta-Analysis
. 2021 Oct 11;22(1):264.
doi: 10.1186/s12931-021-01856-z.

Factors associated with mortality in rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis

Meihua Qiu #  1 , Jing Jiang #  1 , Xueyuan Nian  2 , Yutie Wang  3 , Pengfei Yu  1 , Jie Song #  4 , Shenchun Zou #  5
Affiliations
Meta-Analysis

Factors associated with mortality in rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis

Meihua Qiu et al. Respir Res. .

Abstract

Background: Interstitial lung disease (ILD) is a common and potentially life-threatening complication for rheumatoid arthritis (RA) patients. However, there is a lack of clear prognostic factors in rheumatoid arthritis-associated interstitial lung disease (RA-ILD) patients. The purpose of this study was to complete a systematic review and meta-analysis of the factors associated with mortality in RA-ILD patients.

Methods: Medline, EMBASE and the Cochrane Library were searched up to September 1, 2020. The Newcastle-Ottawa Scale (NOS) was applied to assess the methodological quality of the eligible studies. Study characteristics and magnitude of effect sizes were extracted. Then, pooled hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) and pooled risk ratios (RRs) with 95% CIs were calculated to assess the factors associated with mortality in RA-ILD.

Results: Twenty-three of 3463 articles were eligible, and ten factors associated with mortality for RA-ILD were evaluated in the meta-analysis. Older age (HRs = 1.04, 95% CI 1.03-1.05), male sex (HRs = 1.44, 95% CI 1.21-1.73), having a smoking history (HRs = 1.42, 95% CI 1.03-1.96), lower diffusing capacity of the lung for carbon monoxide (DLCO)% predicted (HRs = 0.98, 95% CI 0.97-1.00), forced vital capacity (FVC)% predicted (HRs = 0.99, 95% CI 0.98-1.00), composite physiological index (CPI) (HRs = 1.04, 95% CI 1.02-1.06), usual interstitial pneumonia (UIP) pattern on HRCT (HRs = 1.88, 95% CI 1.14-3.10 and RRs = 1.90, 95% CI 1.50-2.39), emphysema presence (HRs = 2.31, 95% CI 1.58-3.39), and acute exacerbation of ILD (HRs = 2.70, 95% CI 1.67-4.36) were associated with increased mortality in RA-ILD, whereas rheumatoid factor (RF) positive status was not associated.

Conclusions: Through this systematic review and meta-analysis, we found that older age, male sex, smoking history, higher CPI, lower DLCO% predicted, lower FVC% predicted, UIP pattern on HRCT, emphysema presence and acute exacerbation of ILD were associated with an increased risk of mortality in RA-ILD.

Keywords: Interstitial lung disease; Meta-analysis; Mortality; Rheumatoid arthritis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The study flow diagram
Fig. 2
Fig. 2
Forrest plots of the meta-analysis for age, male sex, smoking history and DLCO% predicted, FVC% predicted and CPI. Forest plots of HRs for the correlation of age with mortality in RA-ILD (A). Forest plot of HRs for the correlation of male sex with mortality in RA-ILD (B). Forest plot of HRs for the correlation of having a smoking history with mortality in RA-ILD (C). Forest plot of HRs for the correlation of DLCO% predicted with mortality in RA-ILD (D). Forest plot of HRs for the correlation of FVC% predicted with mortality in RA-ILD (E). Forest plot of HRs for the correlation of CPI with mortality in RA-ILD (F). HRs hazard ratios; RA-ILD rheumatoid arthritis-associated interstitial lung disease; DLCO diffusing capacity of the lung for carbon monoxide; FVC forced vital capacity; CPI composite physiological index
Fig. 3
Fig. 3
Forest plots of the meta-analysis for UIP, emphysema presence and acute exacerbation of ILD. Forest plot of HRs for the correlation of the UIP pattern with mortality in RA-ILD (A). Forest plot of RRs for the correlation of the UIP pattern with mortality in RA-ILD (B). Forest plot of HRs for the correlation of emphysema presence with mortality in RA-ILD (C). Forest plot of HRs for the correlation of acute exacerbation of ILD with mortality in RA-ILD (D). HRs hazard ratios; RRs relative ratios; UIP usual interstitial pneumonia; RA-ILD rheumatoid arthritis-associated interstitial lung disease
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