HRCT Score Research Articles

The Role of HRCT chest in COVID-19 Pneumonia

COVID-19 pneumonia is a recently identified lung infection, the hazardous factor of this pneumonia is pandemic dissemination of infection by corona virus. Due to its high mortality and morbidity it has become a threat to the human life. As pneumonia is the commonest manifestation chest x-ray becomes the primary modality of investigation however many symptomatic patients do not have a positive chest X-ray findings hence, HRCT is used as primary modality for both screening as well as a diagnosing COVID-19 pneumonia. It has been observed that in many situations RT-PCR test are negative or inconclusive but the HRCT in such cases is useful and conclusive.
 Aim of the article is to highlight the role of HRCT in diagnosing COVID-19 pneumonia and providing proper guidance to the Clinicians for assessing the response and therapeutic purpose for covid19 pneumonia. recently, HRCT score have also been used to provide the clinicians an idea about the Prognosis of this disease progress.

Efficacy of treatment with corticosteroids for fibrotic hypersensitivity pneumonitis: a propensity score-matched cohort analysis

BackgroundFibrotic hypersensitivity pneumonitis (HP) is a chronic interstitial lung disease caused by allergic responses to repeated exposures to a causative antigen. Therapeutic evidence of the use of corticosteroids to treat fibrotic HP remains lacking, although corticosteroids are recognized as a major treatment option. The purpose of this study was to evaluate the efficacy of corticosteroid treatment in patients with fibrotic HP in a propensity score-matched cohort.MethodsA retrospective review of the medical records from 2005 to 2019 in a single center was conducted, and 144 patients with fibrotic HP were identified. Semiquantitative scores for lung abnormalities on HRCT were evaluated. Patients who received (PDN group) and did not receive (non-PDN group) corticosteroid treatment were matched using a propensity score method. Survival rates, serial changes in pulmonary function and annual changes in HRCT scores were compared in the matched cohort.ResultsIn the matched analysis, 30 individuals in the PDN group were matched with 30 individuals in the non-PDN group, the majority of whom had ILD without extensive fibrosis. The survival rate was significantly better in the PDN group (P = 0.032 for the stratified Cox proportional hazards model; HR, 0.250). The absolute changes in FVC at 6, 12, and 24 months from baseline were significantly better in the PDN group. Fewer patients in the PDN group experienced annual deterioration, as reflected in the HRCT score, due to ground-glass attenuation, consolidation, reticulation, traction bronchiectasis and honeycombing.ConclusionWe demonstrated that corticosteroids improved survival and slowed fibrotic progression in a matched cohort, the majority of whom had ILD without extensive fibrosis. Fibrotic HP with less severe fibrosis may benefit from corticosteroid treatment. We propose that the early initiation of corticosteroids should be considered for fibrotic HP when worsening fibrosis is observed.

Synergistic effect of remdesivir and pegylated interferon alfa 1 beta in treatment of Covid 19

Background: Pharmacological therapies of proven efficacy in corona virus disease 2019 are still lacking with no proven antiviral treatment. Impaired type I interferon activity may be responsible for severe disease in COVID-19 patient. We performed prospective, observational, open-label study to evaluate the efficacy and safety of a single dose of Pegylated IFN-α2b in addition to Remdesivir with moderate to severe COVID-19 cases. Aim: The aim of this study is to assess the role of synergistic effect of Remdesivir and Pegylated Interferon alfa 2 Beta in moderate to severe COIVID-19 disease. Materials and Methods: 24 subjects with moderate to severe covid disease are included. Subjects were given PEG IFN-α2b (1 μg/kg subcutaneous [SC] injection, single dose) plus Remdesivir and other standard treatment protocol (MoHFW).We observed oxygen saturation and respiratory rate at discharge and duration of hospital stay and the impact of comorbidities on the same. Results: In the study at admission mean SpO2 was 90.25 ± 2.454% and at discharge was 95.13 ± 1.872%.At admission mean RR was 23.00 ± 2.670 bpm and at discharge was 18.71 ± 1.546 bpm. Mean duration of illness was 7.88 ± 2.112 days. Mean HRCT score was 12.21 ± 2.889.Mean days of recovery was 7.29 ± 3.329 days. There was no significant change in o2 saturation respiratory rate and duration of illness with respect to co morbidities. Conclusions: This study provides evidence for the potential use of a single dose of 1 μg/kg PEG IFN-α2b in the treatment of moderate COVID-19 disease. The significant improvement in clinical status is likely due to faster viral reduction. Further confirmatory studies are required to support the data observed in this study.

Antimicrobial Potency of Ayurveda Principle based HSP Mixture for Gargling, Steam Inhalation, and Nebulisation in Prevention and Early Management of SARS-COV-2 Disease

Introduction: The SARS-COV-2 disease has become the strongest among all the deadly respiratory diseases in taking the lives of lakhs of humans. The current study adopts the Ayurvedic principle of Samprapti Vighatana i.e. arresting the pathogenesis, through the usage of a novel self-formulated medicine powder named Haridradi Steam Powder (HSP) which is an anti-microbial decoction used for gargling, steam inhalation therapy, and nebulisation in the prevention of SARS-COV-2 disease by reducing the viral load in patients. Methodology: Haridradi Steam Powder (HSP) containing decoction for gargling, steam, and nebulisation by adding 3% normal saline were prepared and given to the -participants as per self-made protocol i.e. gargling was advised for primary contacts, asymptomatic patients, and healthy persons as a preventive tool. High-pressure steam inhalation was advised for mild to moderate symptomatic patients and 3% normal saline nebulisation was advised for moderate symptomatic patients. Results: Out of the total of 30 cases, comprising 22 primary contacts, 3 HRCT atypical viral pneumonia with severity score from 8 to 16, 3 RT-PCR positive patients, and 2 RT-PCR positive patients with HRCT score, a marked improvement was seen in more than 20 subjects within a short span of time. Conclusion: The treatment formulation HSP Mixture is found to be effective yet simple, safe, and cost-effective, and is used in different therapies in the prevention and management of early SARS-COV-2 disease.

TO STUDY THE EFFICACY OF AYURVEDIC TREATMENT IN COVID-19/SARS-COV-2

To overcome COVID-19 infection there is no any precise & effective management plan so far available in contemporary Medicine. Therefore, an attempt of administering Ayurvedic medicines to alleviate signs & symptoms of Novel Corona virus is taken into consideration. A clinical trial was performed in hospital with the combination of pure herbo-mineral Ayurvedic medicines named as ‘Shwashara’ along with modern medicines over 93 infected indoor subjects. In total sample size, 76.34% subjects had co-morbidities, after treatment it is been observed that, 29.58% of these subjects did not need oxygen support. 52.69% of sub-jects had HRCT score more than half. 58.06% were recovered within 7 Days. Out of 471 patients, who re-ceived only modern medicines had death rate of 10.02% and the Subjects treated with both systems of medicines have recorded 2.15% death. The ‘Shwashara’ medicine decreases symptoms of pneumonia & COVID-19, strengthen lungs and reduces death rate significantly.

The Efficacy of Treating Pulmonary Fibrosis and Pulmonary Function Injury in COVID-19 with Fuzheng Huayu Tablets: Study Protocol for a Multicenter Randomized Controlled Trial

Introduction: The patients with COVID-19 could be suffered from pulmonary dysfunction and/or fibrosis in recovery period, but there are no certain drugs or treatment to cope with this situation. Our previous studies indicated that Fuzheng Huayu tablets (FZHY) could regress lung fibrosis induced by bleomycin in animals, and improve pulmonary function in patients with chronic obstructive pulmonary disease. Now we design this trial in order to evaluate the effects of FZHY on pulmonary fibrosis and/or pulmonary function injury in the recovery period of COVID-19 and expect to improve the prognosis. Methods and analysis: This is a randomized, double-blinded, multicenter, placebo-controlled clinical trial from March 1, 2020 to December 31, 2021. 160 patients who had been diagnosed with COVID-19 were enrolled, but currently they are negative in viral test and have developed pulmonary fibrosis or pulmonary dysfunction. They are randomly assigned into control group and experimental group. All patients are given basic treatment such as respiratory function rehabilitation training and vitamin C. The experimental group is given FZHY meanwhile the control group is given placebo. Each patient will be observed for 24 weeks and followed up for 8 weeks. The primary outcome of this trial is the improvement proportion of lung fibrosis judged by HRCT score. Secondary outcomes include six-minute walk distance, clinical symptoms score, oxygen saturation, quality of Life-BREF Score, patient health questionnaire-9 Score and general anxiety disorder-7 score. The safety will also be observed. Ethics and dissemination: This study has been approved by the IRB of Shuguang Hospital affiliated with Shanghai University of TCM. The results will be presented at national as well as international conferences.

Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia.

Objective:The aim of our study was to assess the effect of a short-term treatment with low-moderate corticosteroid (CS) doses by both a quantitative and qualitative assessment of chest HRCT of COVID-19 pneumonia.Methods:CORTICOVID is a single-center, cross-sectional, retrospective study involving severe/critical COVID-19 patients with mild/moderate ARDS. Lung total severity score was obtained according to Chung and colleagues. Moreover, the relative percentages of lung total severity score by ground glass opacities, consolidations, crazy paving, and linear bands were computed. Chest HRCT scores, P/F ratio, and laboratory parameters were evaluated before (pre-CS) and 7–10 days after (post-CS) methylprednisolone of 0.5–0.8 mg/kg/day.Findings:A total of 34 severe/critical COVID-19 patients were included in the study, of which 17 received Standard of Care (SoC) and 17 CS therapy in add-on. CS treatment disclosed a significant decrease in HRCT total severity score [median = 6 (IQR: 5–7.5) versus 10 (IQR: 9–13) in SoC, p < 0.001], as well in single consolidations [median = 0.33 (IQR: 0–0.92) versus 6.73 (IQR: 2.49–8.03) in SoC, p < 0.001] and crazy paving scores [mean = 0.19 (SD = 0.53) versus 1.79 (SD = 2.71) in SoC, p = 0.010], along with a significant increase in linear bands [mean = 2.56 (SD = 1.65) versus 0.97 (SD = 1.30) in SoC, p = 0.006]. GGO score instead did not significantly differ at the end of treatment between the two groups. Most post-CS GGO, however, derived from previous consolidations and crazy paving [median = 1.5 (0.35–3.81) versus 2 (1.25–3.8) pre-CS; p = 0.579], while pre-CS GGO significantly decreased after methylprednisolone therapy [median = 0.66 (0.05–1.33) versus 1.5 (0.35–3.81) pre-CS; p = 0.004]. CS therapy further determined a significant improvement in P/F levels [median P/F = 310 (IQR: 235.5–370) versus 136 (IQR: 98.5–211.75) in SoC; p < 0.001], and a significant increase in white blood cells, lymphocytes, and neutrophils absolute values.Conclusion:The improvement of all chest HRCT findings further supports the role of CS adjunctive therapy in severe/critical COVID-19 pneumonia.

Carbohydrate antigen 15-3 as a marker of disease severity in patients with chronic hypersensitivity pneumonitis.

ABSTRACTObjective:Biomarkers associated with mucin 1, such as Krebs von den Lungen-6 and carbohydrate antigen (CA) 15-3, are increased in various interstitial lung diseases. Our aim was to determine whether CA 15-3 could be considered a biomarker of disease severity in patients with chronic hypersensitivity pneumonitis (cHP). Methods:This was a prospective observational study involving adult patients with cHP. Serum levels of CA 15-3 were measured and were correlated with variables related to disease severity and extension. HRCT scans were quantitatively analyzed using a computational platform and an image analysis tool (Computer Aided Lung Informatics for Pathology Evaluation and Rating). CA 15-3 levels were normalized by logarithmic transformation. Results:The sample comprised 41 patients. The mean age of the patients was 60.1 ± 11.6 years. The mean FVC in % of predicted was 70.3% ± 17.3%, and the median of the serum level of CA 15-3 was 48.1 U/mL. CA 15-3 levels inversely correlated with FVC in % of predicted (r = −0,30; p = 0,05), DLCO in % of predicted (r = −0,54; p < 0,01), and SpO2 at the end of a 4-min step test (r = −0,59; p < 0,01), but they directly correlated with total quantitative HRCT scores (r = 0,47; p = 0,004), especially regarding ground-glass opacities (r = 0.58; p < 0,001). Conclusions:CA 15-3 is likely to be a biomarker of disease severity of patients with cHP, particularly regarding gas exchange abnormalities.

The qualitative and quantitative high-resolution computed tomography in the evaluation of interstitial lung diseases

BackgroundHigh-resolution computed tomography (HRCT) is the most accepted imaging tool for the detection, characterization, and monitoring of interstitial lung diseases (ILDs). The correct interpretation of HRCT findings still represents often a problem for the radiologists since there is wide interobserver variability. Therefore, a quantitative and noninvasive imaging method able to permit an accurate assessment of ILD is highly desirable. The purpose of this study is to compare the visual method and quantitative CT histogram in the evaluation of ILDs and to identify the best quantitative parameter in the prediction of severity of ILDs.ResultsThere is a correlation between the HRCT score by the qualitative method and CT histogram parameters by the quantitative method in the evaluation of ILDs. Total lung volume inspiratory, mean lung density expiratory, and high attenuation area expiratory showed a significant correlation with the HRCT score.ConclusionThe single best predictor of fibrosis severity in interstitial lung disease is HAAs % expiratory.

Temporal radiographic changes in COVID-19 patients: relationship to disease severity and viral clearance

COVID-19 is “public enemy number one” and has placed an enormous burden on health authorities across the world. Given the wide clinical spectrum of COVID-19, understanding the factors that can predict disease severity will be essential since this will help frontline clinical staff to stratify patients with increased confidence. To investigate the diagnostic value of the temporal radiographic changes, and the relationship to disease severity and viral clearance in COVID-19 patients. In this retrospective cohort study, we included 99 patients admitted to the Renmin Hospital of Wuhan University, with laboratory confirmed moderate or severe COVID-19. Temporal radiographic changes and viral clearance were explored using appropriate statistical methods. Radiographic features from HRCT scans included ground-glass opacity, consolidation, air bronchogram, nodular opacities and pleural effusion. The HRCT scores (peak) during disease course in COVID-19 patients with severe pneumonia (median: 24.5) were higher compared to those with pneumonia (median: 10) (p = 3.56 × 10 −12), with more frequency of consolidation (p = 0.025) and air bronchogram (p = 7.50 × 10−6). The median values of days when the peak HRCT scores were reached in pneumonia or severe pneumonia patients were 12 vs. 14, respectively (p = 0.048). Log-rank test and Spearman’s Rank-Order correlation suggested temporal radiographic changes as a valuable predictor for viral clearance. In addition, follow up CT scans from 11 pneumonia patients showed full recovery. Given the values of HRCT scores for both disease severity and viral clearance, a standardised HRCT score system for COVID-19 is highly demanded.

Changes in mucociliary clearance over time in children with cystic fibrosis.

(a) To quantify changes in mucociliary clearance (MCC) over time in children with cystic fibrosis (CF) and the relationship between MCC and rate of infection with Pseudomonas aeruginosa (PA); (b) to determine the impact of MCC on the evolution of CF lung disease; and (c) to explore the role of mucus composition as a determinant of MCC. Children with CF, who had previously undergone an MCC measurement (visit 1), underwent the following tests 3 to 10 years later: (a) second MCC measurement (visit 2); (b) multiple breath washout to assess ventilation inhomogeneity, expressed as lung clearance index (LCI); (c) high resolution computed tomography lung scan (HRCT); and (d) induced sputum test. Number of PA + cultures/year between visits was documented and mucus dry weight was quantified in the children and adult controls. Nineteen children completed both visits. Median time between visits was 4.6 years. Clearance declined 30% between visits. Lower MCC on visit 2 was associated with more PA+ cultures/year between visits. Lower MCC values on visit 1 were associated with higher LCI values and higher HRCT scores on visit 2. Mucus dry weight was significantly higher in children with CF compared with controls. Higher dry weights were associated with lower MCC. Mucociliary clearance declines significantly over time in children with CF. The decline is associated with PA infection rate and is affected by mucus composition. Children with early slowing of MCC appear to be at risk for developing ventilation inhomogeneity and parenchymal lung damage when they are older.

The association between single nucleotide polymorphism of interleukin-1β gene rs1143627 site and susceptibility to active tuberculosis

Objective: To investigate the relationship between single nucleotide polymorphism (SNP) of IL-1β gene and susceptibility to tuberculosis. Methods: A case-control study was conducted in Shenzhen Third People's Hospital from January 2012 to December 2014. A total of 1 533 patients with active tuberculosis were enrolled, including 1 432 cases of pulmonary tuberculosis[920 males and 512 females, mean age (37±14) years] and 101 cases of extrapulmonary tuberculosis [60 males and 41 females, mean age (35±13) years]. At the same time, 1 445 healthy controls (882 males and 563 females, mean age (37±20) years) were selected. The genotypes of rs1143627, rs1143623, rs16944 and rs2853550 of IL-1β gene were detected by time-of-flight mass spectrometry. The allele frequencies of rs1143627 T>C (-31) were compared between patients with pulmonary tuberculosis and those with extrapulmonary tuberculosis. Fifty-three patients with active tuberculosis [male 32, female 21, mean age (37±15) years] were randomly selected, and the correlation between SNP alleles and tuberculosis severity was analyzed before and after treatment. Results: Time-of-flight mass spectrometry effectively detected the genotypes of 4 SNP loci. Among the 4 SNP loci, only the allele frequency of -31 locus was significantly different between the active tuberculosis group and the control group. The allele frequency of rs1143627 T locus in active tuberculosis group was 53.3%(1 634/3 066), which was significantly higher than that in the healthy control group 48.7%(1 407/2 890; OR=1.20, 95%CI=1.09-1.33, P=0.001 6) .The frequencies of the other 3 SNP alleles were not significantly different between the active tuberculosis group and the control group. The frequencies of the other 3 SNP alleles were 59% (1 821/3 066) and 60% (1 732/2 890) for rs1143623 G allele, 51% (1 574/3 066) and 52% (1 499/2 890) for rs16944 G allele, and 64% (1 964/3 066) and 65% (1 875/2 890) for rs2853550 T allele respectively. Stratified analysis showed that the frequency of the -31 T allele in patients with extrapulmonary tuberculosis (62.9%, 127/202) was significantly higher than that in patients with pulmonary tuberculosis (52.6%,1 507/2 864) (OR=1.53; 95% CI=1.13-2.05; P=0.005).The HRCT scores of patients with rs1143627 TT, TC and CC genotypes were 26.6, 13.9 and 13.3 respectively before anti-tuberculosis treatment, and after 2 years of anti-tuberculosis treatment, the HRCT scores of patients with rs1143627 TT, TC and CC genotypes were 14.7, 6.6 and 5.4 respectively, which indicated that TB patients with rs1143627T allele were associated with more severe pulmonary disease. Conclusion: The SNP of IL-1β-31T>C was associated with susceptibility to active tuberculosis, and T allele was the susceptible gene and individuals carrying T allele were more likely to develop extrapulmonary tuberculosis.

Increased serum soluble programmed death ligand 1(sPD-L1) is associated with the presence of interstitial lung disease in rheumatoid arthritis: A monocentric cross-sectional study.

This paper is to examine the relationship between serum soluble programmed death ligand 1(sPD-L1) levels and the development of interstitial lung disease (ILD) in patients with rheumatoid arthritis (RA). Serum sPD-L1 were measured by enzyme-linked immunosorbent assay. sPD-L1 levels in RA with ILD, RA without ILD and healthy controls were compared. Associations between ILD and various markers including sPD-L1 and confounding factors were investigated by logistic regression analysis. Diagnostic values of sPD-L1 for the presence of ILD were investigated using receiver operating characteristics curve analysis. Serum sPD-L1 levels were higher in RA patients with ILD than RA patients without ILD and healthy controls (23.7±9.8 vs. 18.0±7.7pg/mL, P=0.01 and 23.7±9.8 vs. 2.9±1.5pg/mL, P<0.0001). sPD-L1 levels were positively correlated with RF titer (r=0.245, P=0.03), CRP (r=0.265,P=0.01), HRCT score (r=0.265, P=0.04) and Ferritin (r=0.442, P=0.01), but negatively associated with FVC% (r=-0.359, P=0.01) and DLCO% (r=-0.399, P=0.008). sPD-L1 and anti-CCP antibody status were independently associated with the presence of ILD during multivariate logistic regression analysis. Sensitivity and specificity of sPD-L1 levels for the detection of ILD in RA patients were 51.7% and 79.3%, respectively (area under the curve=0.661). Serum sPD-L1 levels were increased in RA patients with ILD. Increased sPD-L1 levels were associated with the presence of ILD.

Noninvasive positive pressure ventilator deteriorates the outcome of pneumomediastinum in anti-MDA5 antibody-positive clinically amyopathic dermatomyositis

Anti-melanoma differentiation-associated gene 5 (MDA5) antibody (Ab)-positive clinically amyopathic dermatomyositis (CADM) with pneumomediastinum (PNM) is a life-threatening condition. We aim to determine the prognostic factors affecting survival of patients with anti-MDA5 Ab-positive CADM complicated with PNM. We retrospectively established a cohort of patients with anti-MDA5 Ab-positive CADM complicated with PNM from April 2013 to July 2019. Demographic data and clinical characteristics from medical records were analyzed and variables were compared between survivors and nonsurvivors. We performed univariate and multivariate survival analyses by Cox regression. Survival curves were depicted by the Kaplan-Meier method. Among 133 patients with anti-MDA5 Ab-positive CADM, 20 were diagnosed with PNM. The cumulative estimated Kaplan-Meier survival rate was 85% at 1week, 55% at 1month, and 40% at 1year. Univariate analysis indicated several factors associated with survival. Worse liver function (AST, p = 0.043; LDH, p = 0.002; TBIL, p = 0.038), higher CRP level (p = 0.044), higher HRCT score (p = 0.022), and using noninvasive positive pressure ventilation (NPPV) (p < 0.01) were associated with poor prognosis. In a multivariate Cox regression model, AST level and using NPPV were indicated to be independent predictors of poor prognosis. In this research, we found that the incidence rate of PNM in anti-MDA5 Ab-positive CADM was 15.5%, obviously higher than in classical DM. The application of noninvasive positive pressure ventilator (NPPV) and higher AST level were independent risk factors for survival.Key Points• Anti-MDA5 Ab-positive CADM complicated with PNM is a life-threatening condition with an incidence rate of 15.5%.• The application of NPPV and worse liver function were independent risk factors for survival of anti-MDA5 Ab-positive CADM patients complicated with PNM.

A Scoring System with High-Resolution Computed Tomography to Predict Drug-Associated Acute Respiratory Distress Syndrome: Development and Internal Validation

Drugs can cause acute respiratory distress syndrome (ARDS). However, there is no established clinical prediction rule for drug-associated ARDS (DARDS). We aimed to develop and validate a scoring system for DARDS prediction. We analysed data collected from a prospective, single-centre, cohort study that included ARDS patients. The ARDS diagnosis was based on the American-European Consensus Conference or Berlin definition. Drug-associated acute lung injury (DALI) was defined as previous exposure to drugs which cause ALI and presence of traditional risk factors for ALI. High-resolution computed tomography (HRCT; indicating extent of lung damage with fibroproliferation), Acute Physiology and Chronic Health Evaluation (APACHE) II, and disseminated intravascular coagulation (DIC; indicating multiorgan failure) scores and PaO2/FiO2 were evaluated for their ability to predict DARDS. Twenty-nine of 229 patients had DARDS. The HRCT, APACHE II, and DIC scores and PaO2/FiO2 were assessed. The model-based predicted probability of DARDS fitted well with the observed data, and discrimination ability, assessed through bootstrap with an area under the receiver-operating curve, improved from 0.816 to 0.875 by adding the HRCT score. A simple clinical scoring system consisting of the APACHE II score, PaO2/FiO2, and DIC and HRCT scores can predict DARDS. This model may facilitate more appropriate clinical decision-making.

Relationship between clinical severity of "new" bronchopulmonary dysplasia and HRCT abnormalities in VLBW infants.

To assess the relationship between HRCT abnormalities and the clinical severity of "new" bronchopulmonary dysplasia (BPD) and respiratory assistance in <1500 g preterm infants. HRCT was performed at the time of discharge in 109 preterm infants with BPD who were born between 2008 and 2014. BPD severity was defined as mild, moderate, or severe according to the NIH diagnostic criteria. Total HRCT scores for each infant were obtained from the sum of the number of BPD lobes assessed by two radiologists: a hyperaeration score (Hs) composed of decreased attenuation, mosaic attenuation, and bulla/bleb, and a parenchyma score (Ps) composed of linear lesions, consolidation, bronchial wall thickening, and bronchiectasis. We compared HRCT scores based on BPD severity and respiratory modes, such as invasive mechanical ventilation (IMV), non-invasive MV (NIMV), and oxygen therapy. Among the group of included infants (n = 101), mild BPD was found in 46.5%, moderate BPD in 45.5%, and severe BPD in 7.9%. When partial correlation was adjusted by gestational age (GA) and birth weight, the duration of NIMV was correlated with Ps (r = 0.382, P < 0.001), Hs (r = 0.223, P = 0.027), and total score (r = 0.384, P < 0.001). The duration of oxygen therapy was correlated with Ps (r = 0.374, P < 0.001) and Hs (r = 0.227, P = 0.023). Ps showed a correlation with BPD severity (r = 0.381, P = 0.007) in infants born at ≤26 weeks (GA) and those born at >27 weeks GA (r = 0.298, P = 0.042). Parenchymal changes showed a greater correlation with the clinical severity of "new" BPD cases, especially in infants born at ≤26 weeks GA. The use of NIMV showed a greater correlation with Ps than Hs.

Visual HRCT Score to Determine Severity and Prognosis of Idiopathic Pulmonary Fibrosis

Visual HRCT Score to Determine Severity and Prognosis of Idiopathic Pulmonary Fibrosis

EMPIRE Registry, Czech Part: Impact of demographics, pulmonary function and HRCT on survival and clinical course in idiopathic pulmonary fibrosis.

Prognostic factors of idiopathic pulmonary fibrosis (IPF) currently recognized include changes in vital capacity and radiologic findings. However, most of the prognostic studies in IPF are based on clinical studies with preselected IPF populations. Therefore, we decided to analyze the factors influencing IPF prognosis based on the real-practice data from our IPF registry. Data of 514 subjects consecutively entered since 2012 into Czech EMPIRE IPF registry were analyzed. Median age of our patient cohort was 67 years (50-82). Median overall survival (OS) of the cohort was 63.1 months. The clinical course of IPF according to FVC (forced vital capacity) changes was stabilized in 32.8% of patients (29.7% according to DLCO [diffuse lung capacity] changes), slowly progressive in 39.5% (45%), rapidly progressive in 23.5% (20.7%); and 1.7% patients had at least one acute exacerbation during follow-up. Deterioration in FVC of ≥10% at month 12 and in DLCO of ≥15% at months 12, 18, and 24 influenced the OS significantly. The fast progressors defined by the DLCO decline rate had higher risk of death compared to those defined by the FVC change over time. In multivariate analysis, age ≥70 years, interstitial HRCT scores ≥3, and change in DLCO of ≥15% at month 12 were confirmed as factors negatively influencing OS. DLCO changes over time were shown as a better predictor of mortality compared with FVC changes in our study. In our opinion it is necessary to implement the DLCO analysis into clinical trials and routine practice.

Residual volume/total lung capacity ratio confers limited additive significance to lung clearance index for assessment of adults with bronchiectasis

BackgroundMosaicism and hyperinflation are common pathophysiologic features of bronchiectasis. The magnitude of ventilation heterogeneity might have been affected by the degree of hyperinflation. Some studies have evaluated the discriminative performance of lung clearance index (LCI) in bronchiectasis patients, but the additive diagnostic value of hyperinflation metrics to LCI is unknown.ObjectiveTo compare LCI and the ratio of residual volume to total lung capacity (RV/TLC), along with the LCI normalized with RV/TLC, in terms of discriminative performance, correlation and concordance with clinical variables in adults with bronchiectasis.MethodsMeasurement items included chest high-resolution computed tomography, multiple-breath nitrogen washout test, spirometry, and sputum culture. We analyzed bronchodilator responses by stratifying LCI and RV/TLC according to their median levels (LCIHigh/RV/TLCHigh, LCILow/RV/TLCHigh, LCIHigh/RV/TLCLow, and LCILow/RV/TLCLow).ResultsData from 127 adults with clinically stable bronchiectasis were analyzed. LCI had greater diagnostic value than RV/TLC in discriminating moderate-to-severe from mild bronchiectasis, had greater concordance in reflecting clinical characteristics (including the number of bronchiectatic lobes, radiological severity score, and the presence of cystic bronchiectasis). Normalization of LCI with RV/TLC did not contribute to greater discriminative performance or concordance with clinical variables. The LCI, before and after normalization with RV/TLC, correlated statistically with age, sex, HRCT score, Pseudomonas aeruginosa colonization, cystic bronchiectasis, and ventilation heterogeneity (all P<0.05). Different bronchodilator responses were not significant among the four subgroups of bronchiectasis patients, including those with discordant LCI and RV/TLC levels.ConclusionLCI is superior to RV/TLC for bronchiectasis assessment. Normalization with RV/TLC is not required. Stratification of LCI and RV/TLC is not associated with significantly different bronchodilator responses.

Clinical Experience with Pirfenidone in Connective Tissue Diseases Related Interstitial Lung Diseases

Objective: Pirfenidone is a new, anti-fibrotic drug used for the treatmentof idiopathic pulmonary fibrosis (IPF). This study was designed to verify the effect of pirfenidone administrated in connective tissue diseases related interstitial lung disease (CTD-ILD). Methods: Twenty two patients diagnosed with CTD-ILD were administrated with a 6-months treatment with or without pirfenidone. At baseline and at months 3rd and 6th, pulmonary function tests, six minute walk distance (6MWD) and HRCT scores were performed. Results: PFD group presented a significant improvement in TLC in the 3rd and 6th month points and DLco was greatly increased in 6th month point, which were all adjusted by the baseline levels, compared with control group (p=0.043, 0.048 and 0.043, respectively). During the follow-up period, TLC was also improved compared to the initial time point and DLco increased obviously in the 6th month point in PFD group (p=0.005, 0.004 and p <0.001 respectively). A lower ground glass score and fibrotic score in the PFD group approached statistical significance after 6-months treatment with pirfenidone when compared with control group (p=0.037 and 0.018, respectively) and decreased greatly in the 6th month point when compared to the former time points in PFD group (p=0.006 and 0.013, respectively), whereas no such changes were observed in the control group. Conclusion: These results suggest that pirfenidone could improve the pulmonary function tests and HRCT scores of connective tissue diseases related interstitial lung disease. It is a potential therapeutic candidate for treatment.