Imaging and serum biomarkers in connective tissue disease–associated interstitial lung diseases: correlation between lung ultrasound B-lines and KL-6 levels

Wang, Yukai; Chen, Shaoqi; Lin, Zhangzhang; Du, Guangyuan; Lin, Jianqun; Lin, Qisheng; Huang, Xiufeng; Zhang, Guohong; Fürst, Daniel E.; Gargani, Luna; Matucci‐Cerinic, Marco

doi:10.1136/annrheumdis-2018-214098

Cited by 11 publications

(6 citation statements)

References 9 publications

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“…To date, few studies have addressed the relationship between serum KL-6 levels and B-lines in IIM-ILD. Our results clearly show that serum KL-6 values directly correlate with B-lines score, in agreement with the data we have provided in a previous study encompassing 60 patients with CTD-ILD ( r = 0.54, P < 0.0001) [ 34 ]. Moreover, we also confirmed the significant correlation between KL-6, the Warrick score and the DLco value.…”

Section: Discussionsupporting

confidence: 93%

Lung ultrasound B-lines and serum KL-6 correlate with the severity of idiopathic inflammatory myositis-associated interstitial lung disease

et al. 2019

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Objective Idiopathic inflammatory myositis-associated interstitial lung disease (IIM-ILD) significantly increases morbidity and mortality. Lung ultrasound B-lines and Krebs von den Lungen-6 (KL-6) are identified as new sonographic and serum markers of ILD, respectively. The aim of our work was to assess the role of B-lines and KL-6 as markers of the severity of IIM-ILD. For this purpose, the correlation among B-lines score, serum KL-6 levels, high-resolution CT (HRCT) score, and pulmonary function tests were investigated in IIM-ILD patients. Methods Thirty-eight patients with IIM-ILD underwent chest HRCT scans, lung ultrasound and pulmonary function tests (independently performed within 1 week) examination. To assess severity and extent of ILD at HRCT, the Warrick score was used. The B-lines score denoting the extension of ILD was calculated by summing the number of B-lines on a total of 50 scanning sites. Serum KL-6 levels (U/ml) was measured by chemiluminescent enzyme immunoassay. Results A significant correlation was found between the B-lines score and serum KL-6 levels (r = 0.43, P < 0.01), and between the Warrick score and serum KL-6 levels (r = 0.45, P < 0.01). A positive correlation between B-lines score and the Warrick score (r = 0.87, P < 0.0001) was also confirmed. Both B-lines score and KL-6 levels inversely correlated to diffusion capacity for carbon monoxide (r = −0.77, P < 0.0001 and r = −0.42, P < 0.05, respectively) and total lung capacity (r = −0.73, P < 0.0001 and r = −0.36, P < 0.05, respectively). Moreover, B-lines correlated inversely with forced vital capacity (r = −0.73, P < 0.0001), forced expiratory volume in 1 s (r = −0.69, P < 0.0001). Conclusion B-lines score and serum KL-6 levels correlate with HRCT findings and pulmonary function tests, supporting their use as measures of IIM-ILD severity.

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Section: Discussionsupporting

confidence: 93%

Lung ultrasound B-lines and serum KL-6 correlate with the severity of idiopathic inflammatory myositis-associated interstitial lung disease

et al. 2019

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“…In a retrospective study, comprised of 60 confirmed CTD-ILD patients, including 11 patients with RA-ILD, circulating KL-6 levels correlated positively with the LUS B-line score ( r = 0.54, p < 0.0001) [ 17 ]. The significant relationship was confirmed in 38 patients with IIM-ILD ( r = 0.43, p < 0.01) [ 18 ].…”

Section: Review Of Relevant Medical Literaturementioning

confidence: 99%

“…In the past decade, lung ultrasound (LUS) B-lines and serum Krebs von den Lungen-6 antigen (KL-6) have been recognized as possible novel sensitive biomarkers to detect CTD-ILD [ 14 – 16 ]. In addition, a significant correlation between B-line number and serum KL-6 level was demonstrated recently in patients with CTD-ILD and idiopathic inflammatory myositis–related ILD (IIM-ILD) [ 17 , 18 ]. Based on this background, we believe it might be helpful to integrate LUS and KL-6 to screen and follow up RA patients with ILD.…”

Section: Introductionmentioning

confidence: 99%

The role of lung ultrasound B-lines and serum KL-6 in the screening and follow-up of rheumatoid arthritis patients for an identification of interstitial lung disease: review of the literature, proposal for a preliminary algorithm, and clinical application to cases

et al. 2021

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Screening and follow-up of interstitial lung disease associated with rheumatoid arthritis (RA-ILD) is a challenge in clinical practice. In fact, the majority of RA-ILD patients are asymptomatic and optimal tools for early screening and regular follow-up are lacking. Furthermore, some patients may remain oligosymptomatic despite significant radiological abnormalities. In RA-ILD, usual interstitial pneumonia (UIP) is the most frequent radiological and pathological pattern, associated with a poor prognosis and a high risk to develop acute exacerbations and infections. If RA-ILD can be identified early, there may be an opportunity for an early treatment and close follow-up that might delay ILD progression and improve the long-term outcome.In connective tissue disease–associated interstitial lung disease (CTD-ILD), lung ultrasound (LUS) with the assessment of B-lines and serum Krebs von den Lungen-6 antigen (KL-6) has been recognized as sensitive biomarkers for the early detection of ILD. B-line number and serum KL-6 level were found to correlate with high-resolution computed tomography (HRCT), pulmonary function tests (PFTs), and other clinical parameters in systemic sclerosis–associated ILD (SSc-ILD). Recently, the significant correlation between B-lines and KL-6, two non-ionizing and non-invasive biomarkers, was demonstrated. Hence, the combined use of LUS and KL-6 to screen and follow up ILD in RA patients might be useful in clinical practice in addition to existing tools. Herein, we review relevant literature to support this concept, propose a preliminary screening algorithm, and present 2 cases where the algorithm was used.

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“…In the case of alveolar epithelial lesions, the increased alveolo-capillary permeability resulted in the elevated serum concentration of KL-6 (7). The increased serum KL-6 levels have been found in a majority of ILDs, including idiopathic pulmonary fibrosis, hypersensitivity pneumonitis and multiple connective tissue disease-associated interstitial lung disease (CTD-ILD) (8)(9)(10)(11). KL-6 might serve as a useful biomarker in assessment of disease severity, and prediction of treatment outcome and disease progressing (12,13).…”

Section: Introductionmentioning

confidence: 99%

Serum Krebs von den Lungen-6 concentrations reflect severity of anti-melanoma differentiation-associated protein 5 antibody positive dermatomyositis associated interstitial lung disease

Zhu

Wang

Sun

et al. 2022

Clinical and Experimental Rheumatology

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ObjectiveRapidly progressive interstitial lung disease (RP-ILD) is a major complication of anti-melanoma differentiation-associated protein 5 antibody positive dermatomyositis (anti-MDA5 + DM) with a high mortality rate. The aim of the study is to determine whether serum Krebs von den Lungen-6 (KL-6) could be a prognostic biomarker to predict RP-ILD and prognosis in anti-MDA5 + DM patients. Methods A total of 21 anti-MDA5 + DM patients with RP-ILD and 20 anti-MDA5 + DM patients without RP-ILD were retrospectivelyincluded in this study. Serum KL-6 concentration (pg/mL) was measured using the latex agglutination test.

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Imaging and serum biomarkers in connective tissue disease–associated interstitial lung diseases: correlation between lung ultrasound B-lines and KL-6 levels

Cited by 11 publications

References 9 publications

Lung ultrasound B-lines and serum KL-6 correlate with the severity of idiopathic inflammatory myositis-associated interstitial lung disease

Lung ultrasound B-lines and serum KL-6 correlate with the severity of idiopathic inflammatory myositis-associated interstitial lung disease

The role of lung ultrasound B-lines and serum KL-6 in the screening and follow-up of rheumatoid arthritis patients for an identification of interstitial lung disease: review of the literature, proposal for a preliminary algorithm, and clinical application to cases

Serum Krebs von den Lungen-6 concentrations reflect severity of anti-melanoma differentiation-associated protein 5 antibody positive dermatomyositis associated interstitial lung disease

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