Acute exacerbation of interstitial lung diseases and mortality post-cryobiopsy: a multicenter cohort study

Abstract

Background: Interstitial lung diseases (ILDs) are a group of pulmonary disorders affecting the lung's structure. Acute exacerbation of ILD (AE-ILD) following medical procedures is a significant clinical concern. Lung cryoprobe transbronchial biopsy (cryobiopsy) is a relatively new diagnostic technique for ILD, but data on AE-ILD post-cryobiopsy is limited. This study aims to fill this gap by examining the prevalence, risk factors, and outcomes of AE-ILD following cryobiopsy.

Methods: This multicenter retrospective study analyzed data from patients who underwent cryobiopsy for ILD diagnosis at three U.S. institutions between January 2014 and August 2022. The study included patients over 18 years with confirmed or suspected ILD, categorized into those who experienced AE-ILD post-cryobiopsy and those who did not.

Results: Out of 111 patients, 3.6% experienced AE-ILD, with a 50% mortality rate in these cases. The study cohort was predominantly white, with a median age of 69.0 years. Common comorbidities included tobacco use and hypertension. Patients who developed AE-ILD had an increased median number of biopsies. The overall 30-day mortality was 1.8%. Overall complication rate was 32%, including pneumonia, pneumothorax, AE-ILD, and bleeding requiring intervention. The study findings suggest that bronchoscopic cryobiopsy may be associated with lower overall mortality, particularly in patients with compromised lung function.

Conclusions: This study provides significant insights into AE-ILD following cryobiopsy, underscoring the need for careful patient selection and procedural assessment. While cryobiopsy may offer a safer alternative to surgical lung biopsy in specific patient cohorts, the elevated risk of AE-ILD necessitates further research to optimize patient outcomes and procedural safety.

Keywords: Diffuse parenchyma lung disease; acute exacerbation of interstitial lung disease (AE-ILD); cryobiopsy; interventional pulmonology.

Figure 1

Lung parenchyma pre- and post-ILD exacerbation. (A,B) Show axial and coronal views respectively of CT chest prior to cryobiopsy demonstrating unspecified ILD. (C,D) Show axial and coronal views at similar levels 24 hours post cryobiopsy with small bilateral pneumothoraces with diffuse ground glass infiltrates consistent with AE-ILD. CT, computed tomography; ILD, interstitial lung disease; AE-ILD, acute exacerbation of interstitial lung disease.