P223 Predictors of mortality in idiopathic inflammatory myopathy-associated interstitial lung disease - a systematic review and meta-analysis
Notice bibliographique
Résumé
Abstract Background/Aims Interstitial Lung Disease (ILD) affects approximately 30% of patients with idiopathic inflammatory myopathies (IIM). It is a leading cause of morbidity and mortality in IIM patients. Natural history of ILD varies widely from rapidly-progressive to indolent with minimal symptoms. IIM describes a collection of related autoimmune, inflammatory disorders predominantly affecting combinations of muscles, skin and lungs. Improving understanding of ILD clinical course will aid prognostication and guide sub-categorisation to improve future research in the field. We performed a systematic review and meta-analysis of prognostic factors in IIM-ILD. Methods MEDLINE and EMBASE databases were interrogated on 18/03/2021 using a pre-defined search protocol (PROSPERO ID:CRD42021240206). Studies providing summary data relating to numbers of survivors vs non-survivors according to any baseline criteria were selected. Baseline characteristics reported in ≥ 5 papers were included for meta-analysis. Risk of bias was assessed by Newcastle-Ottawa score. Stata-16 software was used for meta-analyses using a random effects model to report difference as odds ratio for binary variables, and hedge’s g standardised mean difference for continuous variables. A continuity correction was applied for zero effect studies. Heterogeneity was measured by I2, and publication bias assessed with Egger’s test. Results The search returned 4211 articles. 722 were relevant for abstract review, with 454 requiring full text assessment. 78 studies were eligible for inclusion. Overall mortality was 26.1% (+/-0.14 SD). 62 studies were from Asia, two from Mexico and four from Europe, with mortality rates of 26.5%, 13.6% and 25.3% respectively. The strongest risk factor is anti-MDA-5 antibody (OR 6.03). Conversely anti-tRNA-synthetase antibodies (ARS) are protective. When ARS+ was compared to MDA-5-/ARS- patients only, this difference between the groups disappeared. Anti-MDA-5 titre showed a non-significant effect direction towards higher mortality. ANA, anti-SS-A/Ro52 did not significantly impact mortality. Clinical predictors of increased mortality were male gender, acute/sub-acute onset, clinically amyopathic disease (CADM), dyspnoea, ulceration, fever and increasing age. Additional investigations shown to positively predict mortality were CRP, ferritin, LDH, AaO2 gradient, ground glass opacity and fibrosis HRCT scores. Whereas higher SP-D, lymphocytes, %FVC and %DLCO were protective. Conclusion Whilst many factors were associated with increased mortality in IIM-ILD, heterogeneity between studies is high with all having moderate to high risk of bias. A majority of the data come from studies in Japanese and Chinese populations where anti-MDA5 disease appears to be particularly prevalent and associated with deleterious outcomes. Extrapolating to local populations may not be appropriate. The domination of studies by anti-MDA5 disease may be masking risk factors relevant to other IIM subgroups. Due to the rarity of IIMs, these subgroups are often researched together, however this meta-analysis highlights the need to better categorise IIM patients in clinical research. Disclosure J.R. Hannah: None. T. Gordon: None. M. Rooney: None. J. Galloway: None. P. Gordon: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,009 | 0,025 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,017 | 0,033 |
| Bibliométrie | 0,008 | 0,009 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».