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. 2024 Nov 27:11:1465753.
doi: 10.3389/fmed.2024.1465753. eCollection 2024.

Determinants for worsening in systemic autoimmune rheumatic disease-associated interstitial lung disease: a systematic review and meta-analysis of cohort studies

Jiaheng Yao  1   2   3 , Jun Wang  3 , Luhan Guo  1   2   3 , Peipei Su  4 , Jiansheng Li  1   2   3 , Bin Li  1   2   3
Affiliations

Determinants for worsening in systemic autoimmune rheumatic disease-associated interstitial lung disease: a systematic review and meta-analysis of cohort studies

Jiaheng Yao et al. Front Med (Lausanne). .

Abstract

Background: To identify risk factors for progression, acute exacerbation (AE), and the development of rapidly progressive interstitial lung disease (RP-ILD) in Systemic autoimmune rheumatic disease-associated interstitial lung disease (SARD-ILD).

Methods: We systematically searched PubMed, EMBASE, Scopus, the Cochrane Library, and Web of Science databases to identify eligible cohort studies up until January 01, 2024. Two reviewers independently screened the literature and extracted data. We employed the Newcastle-Ottawa Scale (NOS) to assess study quality and performed meta-analyses using STATA software.

Results: This review included 50 studies. For progression, 28 studies were included, four significant risk factors were identified: male (OR = 1.97, 95% CI 1.26-3.08, p < 0.001), UIP patterns on HRCT (OR = 1.94, 95% CI 1.48-2.54, p < 0.001), extensive lung involvement (OR = 2.15, 95% CI 1.66-2.80, p < 0.001), and age (OR = 1.07, 95% CI 1.05-1.10, p < 0.001); and 11 potential risk factors. Seven studies were included in AE, and three potential risk factors were highlighted: FVC, UIP patterns on HRCT, and smoking history. In RP-ILD, 15 studies were included. Three risk factors were determined: High CRP (OR = 2.45, 95% CI 1.87-3.21, p < 0.001), Ro-52 positivity (OR = 5.35, 95% CI 3.46-8.29, p < 0.001), and MDA5 antibodies (OR = 2.09, 95% CI 1.47-2.95, p < 0.001); along with 10 potential risk factors.

Conclusion: Our meta-analysis identified male sex, UIP pattern on HRCT, extensive lung involvement, and advanced age as significant risk factors for the progression of SARD-ILD. High CRP, Ro-52 positivity, and MDA5 antibodies were significant risk factors for developing of RP-ILD in patients with IIM. We also discovered several potential risk factors that may be associated with the progression of SARD-ILD and acute exacerbation, as well as the occurrence of RP-ILD in IIM patients.

Systematic review registration: https://www.crd.york.ac.uk/prospero/.

Keywords: acute exacerbation; interstitial lung disease; meta-analysis; progression; rapidly progressive interstitial lung disease; risk factors; systematic review; systemic autoimmune rheumatic 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
Flow diagram showing literature search and results.
Figure 2
Figure 2
Forest plot of risk factors for progression of SARD-ILD.
Figure 3
Figure 3
Forest plot of risk factors for AE of SARD-ILD.
Figure 4
Figure 4
Forest plot of risk factors for RP-ILD.
See this image and copyright information in PMC

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