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. 2023 Aug 24:14:1209282.
doi: 10.3389/fimmu.2023.1209282. eCollection 2023.

Predictors of rapidly progressive interstitial lung disease and prognosis in Chinese patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis

Meiqi Li  1 , Xuli Zhao  2 , Baocheng Liu  1 , Yaqi Zhao  3 , Xinya Li  1 , Zhenzhen Ma  1   3 , Qingrui Yang  1   3
Affiliations

Predictors of rapidly progressive interstitial lung disease and prognosis in Chinese patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis

Meiqi Li et al. Front Immunol. .

Abstract

Background: Rapidly progressive interstitial lung disease (RP-ILD) is the most serious complication of anti-melanoma differentiation-associated gene 5-positive dermatomyositis (anti-MDA5+ DM). This study was performed to assess the prognostic factors of patients with anti-MDA5+ DM and the clinical characteristics and predictors of anti-MDA5+ DM in combination with RP-ILD.

Methods: In total, 73 MDA5+ DM patients were enrolled in this study from March 2017 to December 2021. They were divided into survival and non-survival subgroups and non-RP-ILD and RP-ILD subgroups.

Results: The lactate dehydrogenase (LDH) concentration and prognostic nutritional index (PNI) were independent prognostic factors in patients with anti-MDA5+ DM: the elevated LDH was associated with increased mortality (p = 0.01), whereas the elevated PNI was associated with reduced mortality (p < 0.001). The elevated LDH was independent risk prognostic factor for patients with anti-MDA5+ DM (HR 2.42, 95% CI: 1.02-4.83, p = 0.039), and the elevated PNI was independent protective prognostic factor (HR, 0.27; 95% CI, 0.08 - 0.94; p = 0.039). Patients who had anti-MDA5+ DM with RP-ILD had a significantly higher white blood cell count and LDH concentration than those without RP-ILD (p = 0.007 and p = 0.019, respectively). In contrast, PNI was significantly lower in patients with RP-ILD than those without RP-ILD (p < 0.001). The white blood cell count and elevated LDH were independent and significant risk factors for RP-ILD (OR 1.54, 95% CI: 1.12 - 2.13, p = 0.009 and OR 8.68, 95% CI: 1.28 - 58.83, p = 0.027, respectively), whereas the lymphocyte was an independent protective factor (OR, 0.11; 95% CI, 0.01 - 0.81; p = 0.03).

Conclusion: The elevated LDH and elevated PNI were independent prognostic factors for patients with anti-MDA5+ DM. The elevated LDH was independent risk factor for RP-ILD. Patients with anti-MDA5+ DM could benefit from the measurement of LDH and PNI, which are inexpensive and simple parameters that could be used for diagnosis as well as prediction of the extent of lung involvement and prognosis.

Keywords: anti-melanoma differentiation-associated protein 5 antibody; dermatomyositis; lactate dehydrogenase; prognosis; rapidly progressive interstitial lung disease.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study cohort.
Figure 2
Figure 2
Kaplan–Meier survival curves for overall survival of patients with anti-MDA5+ DM, stratified by (A) Low/high LDH; (B) Low/high PNI; (C) Non-RP-ILD/with RP-ILD.
Figure 3
Figure 3
Forest plot of multivariate COX analysis of prognostic factors in patients with anti-MDA5+ DM.
Figure 4
Figure 4
ROC curves for WBC count, LDH concentration, and WBC count combined with LDH concentration for predicting MDA5+ DM combined with RP-ILD.
Figure 5
Figure 5
Risk factors of RP-ILD in patients with anti-MDA5+ DM.
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