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Michi Tanaka, Ryuji Koike, Ryoko Sakai, Kazuyoshi Saito, Shintaro Hirata, Hayato Nagasawa, Hideto Kameda, Masako Hara, Yasushi Kawaguchi, Shigeto Tohma, Yoshinari Takasaki, Makoto Dohi, Yasuhiko Nishioka, Shinsuke Yasuda, Yasunari Miyazaki, Yuko Kaneko, Toshihiro Nanki, Kaori Watanabe, Hayato Yamazaki, Nobuyuki Miyasaka, Masayoshi Harigai, Pulmonary infections following immunosuppressive treatments during hospitalization worsen the short-term vital prognosis for patients with connective tissue disease-associated interstitial pneumonia, Modern Rheumatology, Volume 25, Issue 4, 22 June 2015, Pages 609–614, https://doi.org/10.3109/14397595.2014.980384
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Abstract
Objective. Connective tissue disease-associated interstitial pneumonia (CTD-IP) significantly affects the mortality of patients with CTD. The purpose of the present study is to identify causes and risk factors for death during hospitalization for immunosuppressive treatment of CTD-IP.
Methods. A multicenter, retrospective study was conducted that collected data from patients with CTD who had been hospitalized for commencing or intensifying immunosuppressive treatment of CTD-IP using a standardized case report form. Risk factors were identified using the Cox proportional hazard regression model.
Results. A total of 322 CTD-IP patients were enrolled with rheumatoid arthritis (n = 84), systemic lupus erythematosus (n = 13), polymyositis (n = 33), dermatomyositis (n = 69), systemic sclerosis (n = 55), mixed connective tissue disease (n = 21), microscopic polyangiitis (n = 19), and overlap syndrome (n = 28). Of the 42patients who died during hospitalization, 22 died from CTD-IP, 15 from CTD-IP and pulmonary infection, 2 from pulmonary infection, and 3 from other causes. Age ≥ 65 years and development of pulmonary infections after commencing or intensifying immunosuppressive treatments were identified as risk factors for death during hospitalization after adjusting for covariates.
Conclusion. Careful consideration of the benefit–risk balance of immunosuppressive treatment for CTD-IP is indispensable for improving the short-term vital prognosis of these patients.