Risk prediction model in rheumatoid arthritis‐associated interstitial lung disease

• Published in: Respirology (Carlton, Vic.) Vol. 25; no. 12; pp. 1257 - 1264
• Main Authors: Kim, Ho Cheol, Lee, Jeong Seok, Lee, Eun Young, Ha, You‐Jung, Chae, Eun Jin, Han, Minkyu, Cross, Gary, Barnett, Joseph, Joseph, Jacob, Song, Jin Woo
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.12.2020; Wiley Subscription Services, Inc
• Subjects: Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - epidemiology; Cohort Studies; diagnostic; Emphysema; Female; Fibrosis; Humans; imaging; interstitial lung disease; Lung diseases; Lung Diseases, Interstitial - diagnosis; Lung Diseases, Interstitial - epidemiology; Lung Diseases, Interstitial - etiology; Lung Diseases, Interstitial - mortality; Male; Medical prognosis; Middle Aged; Mortality; Prediction models; Prognosis; Proportional Hazards Models; Respiratory diseases; Retrospective Studies; Rheumatoid arthritis; Risk Assessment - methods; Risk Assessment - statistics & numerical data; Risk Factors; Statistical analysis; diagnostic; interstitial lung disease; imaging; prognosis; rheumatoid arthritis
• ISSN: 1323-7799; 1440-1843; 1440-1843
• DOI: 10.1111/resp.13848

ABSTRACT Background and objective RA‐ILD has a variable clinical course, and its prognosis is difficult to predict. Moreover, risk prediction models for prognosis remain undefined. Methods The prediction model was developed using retrospective data from 153 patients with RA‐ILD and validated in an independent RA‐ILD cohort (n = 149). Candidate variables for the prediction models were screened using a multivariate Cox proportional hazard model. C‐statistics were calculated to assess and compare the predictive ability of each model. Results In the derivation cohort, the median follow‐up period was 54 months, and 38.6% of the subjects exhibited a UIP pattern on HRCT imaging. In multivariate Cox analysis, old age (≥60 years, HR: 2.063), high fibrosis score (≥20% of the total lung extent, HR: 4.585), a UIP pattern (HR: 1.899) and emphysema (HR: 2.596) on HRCT were significantly poor prognostic factors and included in the final model. The prediction model demonstrated good performance in the prediction of 5‐year mortality (C‐index: 0.780, P < 0.001); furthermore, patients at risk were divided into three groups with 1‐year mortality rates of 0%, 5.1% and 24.1%, respectively. Predicted and observed mortalities at 1, 2 and 3 years were similar in the derivation cohort, and the prediction model was also effective in predicting prognosis of the validation cohort (C‐index: 0.638, P < 0.001). Conclusion Our results suggest that a risk prediction model based on HRCT variables could be useful for patients with RA‐ILD. The risk prediction model for RA‐ILD patients using age from 60 years onwards and imaging parameters such as extent of fibrosis at ≥20% of the total lung extent, a UIP pattern and emphysema, was effective in predicting prognosis both in the derivation and validation cohorts. See related Editorial