Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience
Yıl: 2022 Cilt: 61 Sayı: 4 Sayfa Aralığı: 524 - 529 Metin Dili: İngilizce İndeks Tarihi: 15-12-2022
Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience
Öz: Aim: Hypersensitivity pneumonitis (HP) is defined as an inflammatory and/or fibrotic immune reaction provoked by an inhalational exposure in susceptible individuals. Initial management of HP patients includes remediation of exposure and treatment with immunosuppressive agents. In this study we aimed to define clinical features and treatment modalities and to evaluate response to corticosteroids in HP patients followed in a single tertiary care setting. Materials and Methods: The patients with HP diagnosis followed between 1 January 2019 and 31 December 2020 were included in this retrospective study. Firstly, the candidate factors related with treatment response were evaluated by univariate analysis and then the possible factors with p values below 0.15 were evaluated by multiple linear regression model to identify independent predictors of systemic corticosteroid response. Results: The study population consisted of 50 HP patients and 20 of them (40%) had fibrotic HP. Forty-one (82.0%) patients were followed with a medical treatment for longer than 3 months. Within follow-up period 15 (36.5%) patients didn’t show clinical or radiological response to systemic corticosteroids. Patients without treatment response were presented as fibrotic HP (66.6% vs 26%, p=0.02), had radiological features of fibrosis (86.6% vs 30.7%, p=0.002) and had loss of pulmonary functions (60.0% vs 34.6%, p=0.03) more frequently. Uni-variable analysis revealed that radiological features of fibrosis (OR: 0.07 [95%CI: 0.01-0.42], p=0.003) and mosaic attenuation (OR: 7.0 [95%CI: 0.30-10.07], p=0.08) in HRCT related with corticosteroid treatment response. Conclusion: Our study suggests radiological features of fibrosis relate with worse clinical and radiological response to corticosteroid treatment. Prospective clinical trials are needed to clarify the role of immunosuppressive therapy in HP patients.
Anahtar Kelime: Hipersensitivite pnömonisi hastalarında sistemik kortikosteroid tedavi yanıtı: bir tek merkez deneyimi
Öz: Amaç: Hipersensitivite pnömonisi (HP) duyarlı bireylerde, inhalasyon yolu ile gelen maruziyetlere karşı gelişen inflamatuar ve/veya fibrotik bir immün yanıt olarak tanımlanmaktadır. HP hastalarının yönetimi maruziyetten kaçınmak ve immunsupresif ajanlarla tedaviyi içermektedir. Çalışmamızda bir üniversite hastanesinde takip edilen HP hastalarının klinik özelliklerini ve kortikosteroid tedaviye yanıtlarını değerlendirmeyi amaçladık. Gereç ve Yöntem: HP tanısı ile 1 Ocak 2019 ve 31 Aralık 2020 tarihleri arasında takip edilen hastalar retrospektif olarak çalışmaya dahil edildi. Tedavi yanıtı ile olasılıkla ilişkili faktörler öncelikte tek değişkenli olarak değerlendirildi. Sonrasında p değeri 0,15 ve altında olan faktörler çok değişkenli lineer regresyon modeli ile değerlendirilerek sistemik kortikosteroid yanıtı ile bağımsız ilişkili olan faktörler tanımlandı. Bulgular: Çalışmamıza dahil edilen 50 HP hastasının 20 (%40,0)’ı fibrotik HP idi. Kırk bir (%82,0) hasta en az 3 aydır medikal tedavi almaktaydı. Takip süresince 15 (%36,5) hasta sistemik kortikosteroid tedavisine klinik veya radyolojik yanıt göstermedi. Tedavi yanıtı izlenmeyen olgular, sıklıkla fibrotik HP ile prezente olmakta (66,6% vs 26,0%, p=0,02), radyolojik olarak fibrozis bulguları göstermekte (%86,6 karşı %30,7, p=0,002) ve takiplerinde solunum fonksiyonlarında kaybı (%60,0 karşı %34,6, p=0,03) daha sık yaşamaktaydı. Tek değişkenli analizlerde radyolojik bulgulardan fibrozis varlığı (OR: 0,07 [95%CI: 0,01-0,42], p=0,003) ve mozaik atenüasyon bulgusu (OR: 7,0 [95%CI: 0,30- 10,07], p=0,08) kortikositeroid tedavi yanıtı ile ilişkili bulundu. Sonuç: Çalışmamız radyolojik olarak fibrozis bulgusunun varlığının kortikosteroid tedaviye kötü klinik ve radyolojik yanıt ile ilişkili olduğunu önermektedir. HP hastalarında immunsupresif tedavinin rolünün belirlenmesi için prospektif klinik çalışmalara ihtiyaç duyulmaktadır.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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APA | Acet Öztürk N, Coskun F, Yurttas A, İbrahimova N, Aydin Guclu O, Demirdöğen E, Gorek Dilektasli A, Ursavas A, Uzaslan E, Karadağ M (2022). Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. , 524 - 529. |
Chicago | Acet Öztürk Nilüfer Aylin,Coskun Funda,Yurttas Ahmet,İbrahimova Nurlana,Aydin Guclu Ozge,Demirdöğen Ezgi,Gorek Dilektasli Asli,Ursavas Ahmet,Uzaslan Esra,Karadağ Mehmet Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. (2022): 524 - 529. |
MLA | Acet Öztürk Nilüfer Aylin,Coskun Funda,Yurttas Ahmet,İbrahimova Nurlana,Aydin Guclu Ozge,Demirdöğen Ezgi,Gorek Dilektasli Asli,Ursavas Ahmet,Uzaslan Esra,Karadağ Mehmet Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. , 2022, ss.524 - 529. |
AMA | Acet Öztürk N,Coskun F,Yurttas A,İbrahimova N,Aydin Guclu O,Demirdöğen E,Gorek Dilektasli A,Ursavas A,Uzaslan E,Karadağ M Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. . 2022; 524 - 529. |
Vancouver | Acet Öztürk N,Coskun F,Yurttas A,İbrahimova N,Aydin Guclu O,Demirdöğen E,Gorek Dilektasli A,Ursavas A,Uzaslan E,Karadağ M Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. . 2022; 524 - 529. |
IEEE | Acet Öztürk N,Coskun F,Yurttas A,İbrahimova N,Aydin Guclu O,Demirdöğen E,Gorek Dilektasli A,Ursavas A,Uzaslan E,Karadağ M "Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience." , ss.524 - 529, 2022. |
ISNAD | Acet Öztürk, Nilüfer Aylin vd. "Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience". (2022), 524-529. |
APA | Acet Öztürk N, Coskun F, Yurttas A, İbrahimova N, Aydin Guclu O, Demirdöğen E, Gorek Dilektasli A, Ursavas A, Uzaslan E, Karadağ M (2022). Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. Ege Tıp Dergisi, 61(4), 524 - 529. |
Chicago | Acet Öztürk Nilüfer Aylin,Coskun Funda,Yurttas Ahmet,İbrahimova Nurlana,Aydin Guclu Ozge,Demirdöğen Ezgi,Gorek Dilektasli Asli,Ursavas Ahmet,Uzaslan Esra,Karadağ Mehmet Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. Ege Tıp Dergisi 61, no.4 (2022): 524 - 529. |
MLA | Acet Öztürk Nilüfer Aylin,Coskun Funda,Yurttas Ahmet,İbrahimova Nurlana,Aydin Guclu Ozge,Demirdöğen Ezgi,Gorek Dilektasli Asli,Ursavas Ahmet,Uzaslan Esra,Karadağ Mehmet Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. Ege Tıp Dergisi, vol.61, no.4, 2022, ss.524 - 529. |
AMA | Acet Öztürk N,Coskun F,Yurttas A,İbrahimova N,Aydin Guclu O,Demirdöğen E,Gorek Dilektasli A,Ursavas A,Uzaslan E,Karadağ M Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. Ege Tıp Dergisi. 2022; 61(4): 524 - 529. |
Vancouver | Acet Öztürk N,Coskun F,Yurttas A,İbrahimova N,Aydin Guclu O,Demirdöğen E,Gorek Dilektasli A,Ursavas A,Uzaslan E,Karadağ M Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience. Ege Tıp Dergisi. 2022; 61(4): 524 - 529. |
IEEE | Acet Öztürk N,Coskun F,Yurttas A,İbrahimova N,Aydin Guclu O,Demirdöğen E,Gorek Dilektasli A,Ursavas A,Uzaslan E,Karadağ M "Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience." Ege Tıp Dergisi, 61, ss.524 - 529, 2022. |
ISNAD | Acet Öztürk, Nilüfer Aylin vd. "Systemic corticosteroid treatment response in hypersensitivity pneumonitis: a single center experience". Ege Tıp Dergisi 61/4 (2022), 524-529. |