Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease

Maria De Santis, Silvia Laura Bosello, Giusy Peluso, Michela Pinnelli, Stefano Alivernini, Gaetano Zizzo, Mario Bocci, Annunziata Capacci, Giuseppe La Torre, Alice Mannocci, Gabriella Pagliari, Francesco Varone, Roberto Pistelli, Francesco Maria Danza, Gianfranco Ferraccioli

Research output: Contribution to journalArticle

Abstract

Introduction: So far no clinical or experimental evidences clearly explain how and which systemic sclerosis (SSc) patients will experience a functional and radiological progression of interstitial lung disease (ILD). Objectives: The aim of the study was to investigate whether any bronchoalveolar lavage fluid (BALF) characteristic, compared with clinical, functional and radiological parameters, is associated with the risk of progression of ILD and worse survival in SSc patients. Methods: Lung involvement was evaluated in 110 consecutively examined SSc patients with pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT); 73 patients with evidence of ILD on HRCT underwent BAL. The progression of ILD was evaluated with PFTs and HRCT after 1-year follow-up. A 36-month survival analysis was assessed. Results: ILD patients with alveolitis had a higher risk to have restrictive lung disease and honeycombing, to experience a worsening in honeycombing score or to develop honeycombing. ILD progression was associated with the evidence of honeycombing on HRCT, with the presence of eosinophils, with an inverted CD4/CD8 ratio and with a higher CD19 percentage count in the BALF or with a positive BALF microbiological culture. The patients with ILD had a worse overall survival. The diffuse disease was the only independent risk factor of overall mortality, and the extent of honeycombing on HRCT was the only independent risk factor of lung disease-related mortality. Conclusion: Our study suggests the importance of evaluating ILD with HRCT and BAL in order to characterize the risk factors of SSc lung involvement progression.

Original languageEnglish
Pages (from-to)9-17
Number of pages9
JournalClinical Respiratory Journal
Volume6
Issue number1
DOIs
Publication statusPublished - Jan 2012

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Interstitial Lung Diseases
Bronchoalveolar Lavage Fluid
Systemic Scleroderma
Tomography
Dimercaprol
Respiratory Function Tests
Lung Diseases
Lung
CD4-CD8 Ratio
Survival
Mortality
Survival Analysis
Eosinophils
Disease Progression

Keywords

  • Alveolitis
  • Honeycombing
  • Interstitial lung disease
  • Systemic sclerosis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Immunology and Allergy
  • Genetics(clinical)

Cite this

Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease. / De Santis, Maria; Bosello, Silvia Laura; Peluso, Giusy; Pinnelli, Michela; Alivernini, Stefano; Zizzo, Gaetano; Bocci, Mario; Capacci, Annunziata; La Torre, Giuseppe; Mannocci, Alice; Pagliari, Gabriella; Varone, Francesco; Pistelli, Roberto; Danza, Francesco Maria; Ferraccioli, Gianfranco.

In: Clinical Respiratory Journal, Vol. 6, No. 1, 01.2012, p. 9-17.

Research output: Contribution to journalArticle

De Santis, M, Bosello, SL, Peluso, G, Pinnelli, M, Alivernini, S, Zizzo, G, Bocci, M, Capacci, A, La Torre, G, Mannocci, A, Pagliari, G, Varone, F, Pistelli, R, Danza, FM & Ferraccioli, G 2012, 'Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease', Clinical Respiratory Journal, vol. 6, no. 1, pp. 9-17. https://doi.org/10.1111/j.1752-699X.2010.00228.x
De Santis, Maria ; Bosello, Silvia Laura ; Peluso, Giusy ; Pinnelli, Michela ; Alivernini, Stefano ; Zizzo, Gaetano ; Bocci, Mario ; Capacci, Annunziata ; La Torre, Giuseppe ; Mannocci, Alice ; Pagliari, Gabriella ; Varone, Francesco ; Pistelli, Roberto ; Danza, Francesco Maria ; Ferraccioli, Gianfranco. / Bronchoalveolar lavage fluid and progression of scleroderma interstitial lung disease. In: Clinical Respiratory Journal. 2012 ; Vol. 6, No. 1. pp. 9-17.
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AU - Bosello, Silvia Laura

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AU - Alivernini, Stefano

AU - Zizzo, Gaetano

AU - Bocci, Mario

AU - Capacci, Annunziata

AU - La Torre, Giuseppe

AU - Mannocci, Alice

AU - Pagliari, Gabriella

AU - Varone, Francesco

AU - Pistelli, Roberto

AU - Danza, Francesco Maria

AU - Ferraccioli, Gianfranco

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N2 - Introduction: So far no clinical or experimental evidences clearly explain how and which systemic sclerosis (SSc) patients will experience a functional and radiological progression of interstitial lung disease (ILD). Objectives: The aim of the study was to investigate whether any bronchoalveolar lavage fluid (BALF) characteristic, compared with clinical, functional and radiological parameters, is associated with the risk of progression of ILD and worse survival in SSc patients. Methods: Lung involvement was evaluated in 110 consecutively examined SSc patients with pulmonary function tests (PFTs) and high-resolution computed tomography (HRCT); 73 patients with evidence of ILD on HRCT underwent BAL. The progression of ILD was evaluated with PFTs and HRCT after 1-year follow-up. A 36-month survival analysis was assessed. Results: ILD patients with alveolitis had a higher risk to have restrictive lung disease and honeycombing, to experience a worsening in honeycombing score or to develop honeycombing. ILD progression was associated with the evidence of honeycombing on HRCT, with the presence of eosinophils, with an inverted CD4/CD8 ratio and with a higher CD19 percentage count in the BALF or with a positive BALF microbiological culture. The patients with ILD had a worse overall survival. The diffuse disease was the only independent risk factor of overall mortality, and the extent of honeycombing on HRCT was the only independent risk factor of lung disease-related mortality. Conclusion: Our study suggests the importance of evaluating ILD with HRCT and BAL in order to characterize the risk factors of SSc lung involvement progression.

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