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

Wang, Yukai; Chen, Shaoqi; Lin, Jianqun; Xie, Xuezhen; Hu, Shijian; Lin, Qisheng; Zheng, Kedi; Du, Guangyuan; Huang, Xiufeng; Zhang, Guohong; Gargani, Luna; Matucci‐Cerinic, Marco; Fürst, Daniel E.

doi:10.1093/rheumatology/kez571

Cited by 29 publications

(24 citation statements)

References 30 publications

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“…Imaging results were quantified and scored, and a comparative analysis of the values at baseline and at 52 weeks showed that KL-6 and SP-A were positively correlated with the CT scores in the aggravation group. Wang et al [ 46 ] and AI-Salmi et al [ 47 ] proposed that serum KL-6 and SP-A were related to HRCT and could be used as indicators for evaluating the progression of ILD. This is consistent with the findings of this study in patients with IPAF.…”

Section: Discussionmentioning

confidence: 99%

Krebs von den Lungen-6 and surfactant protein-A in interstitial pneumonia with autoimmune features

et al. 2021

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Interstitial pneumonia with autoimmune features (IPAF) is a special subtype of interstitial lung disease that has received worldwide attention. Krebs von den Lungen-6 (KL-6) and surfactant protein-A (SP-A) can be used as an important biomarker of interstitial lung disease, but its exact relationship with IPAF is poorly understood. A total of 65 IPAF patients were included in the study and were followed up for 52 weeks. The KL-6 and SP-A were evaluated by chemiluminescence enzyme immunoassay. The above indicators were tested at 2 time points, baseline (the first admission of patients) and 52 weeks. We also collected the indicators of antinuclear antibodies and rheumatoid factor. Based on high-resolution computed tomography evaluations, patients were divided into: aggravation, stable, and improvement group. At same time, 30 age-matched normal people as normal control were recruited, the same information was collected. Correlations among the groups were compared and analyzed. The KL-6 and SP-A level in IPAF patients were significantly higher than normal controls (fold increase = 11.35 and 1.39, both P < .001) and differed significantly at baseline and 52 weeks in IPAF (difference ratio = 37.7% and 21.3%, P < .05, both). There were significant differences at baseline and 52 weeks ( r values of aggravation, improvement, and stable groups for KL-6 were 0.705, 0.770, and 0.344, P = .001, .001, and .163, and for SP-A the r value were 0.672, 0.375, and 0.316, P = .001, .126, and .152). In aggravation group, KL-6 and SP-A were correlated with CT scores (both P < .05). Diffusing capacity of the lung for carbon monoxide (DLCO) and forced vital capacity (FVC), % predicted showed a progressive downward trend, with a significant difference at baseline and 52 weeks in IPAF patients (difference ratio = 23.8% and 20.6%, both P < .05). There was a significant correlation between KL-6 and FVC % predicted and DLCO (both P < .05), SP-A showed negatively correlated with DLCO, but not significantly correlated with FVC % predicted ( P < .05 and .47). This study demonstrated that KL-6 and SP-A can reflect disease progression, and both 2 play a key role at reflection of lung epithelial cell injury and fibrosis degree in IPAF.

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Section: Discussionmentioning

confidence: 99%

Krebs von den Lungen-6 and surfactant protein-A in interstitial pneumonia with autoimmune features

et al. 2021

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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 ]. In a recent case, B-lines and KL-6 were utilized to closely detect and follow a patient with anti-MDA-5-positive, clinically amyopathic dermatomyositis associated with rapidly progressive ILD [ 79 ].…”

Section: Review Of Relevant Medical Literaturementioning

confidence: 91%

“…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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“…Growing evidence demonstrates that most cases of COVID-19 pneumonia correspond to interstitial lung disease. Previous studies have shown that the number of B-lines is strongly associated with HRCT severity score, pulmonary function test parameters, and serum biomarker KL-6 levels in connective tissue disease-associated interstitial lung disease (CTD-ILD) (18)(19)(20). In this pilot study, total B-lines score of LUS and semi-quantitative score of HRCT denoted sonographic and radiological severity, respectively.…”

Section: A B a Bmentioning

confidence: 99%

“…A proportion of COVID-19 patients will progress to develop pneumonia, which is significantly associated with worse prognosis and higher mortality (2,3). The mechanism leading to acute lung injury in COVID- 19 has not yet been fully elucidated. Until now, Chest computed tomography (CT) has been a pivotal diagnostic tool for COVID-19 pneumonia, which can identify early lung inflammation, stratify patients based on imaging manifestations, and closely follow up pulmonary lesion modification (2,3).…”

Section: Introductionmentioning

confidence: 99%

Lung ultrasound correlates with radiographic severity and pattern in COVID-19 pneumonia: a preliminary study

Du¹,

Wang²,

Chen³

et al. 2021

Ann Palliat Med

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Background: Coronavirus Disease 2019 (COVID-19) was outbreaking in late 2019 and a proportion of patients developed to pneumonia. Although chest CT is a pivotal diagnostic tool for COVID-19 pneumonia, CT is expensive and also radiological burden for patients. There is urgent to investigate the role of lung ultrasound (LUS) in diagnosing and monitoring COVID-19 pneumonia.Methods: A total of 8 patients with confirmed cases of COVID-19 pneumonia in Shantou Central Hospital from January 2020 to February 2020 were retrospectively studied. All participants underwent chest HRCT and LUS examination; both were independently performed within 1 day of the other. The radiological patterns were reviewed by 2 radiologists who were blind to the clinical information. A senior ultrasound physician, blind to HRCT results and clinical data, performed bedside LUS in the isolation ward. The CT score was used (a semi-quantitative scoring system) to assess radiographic severity and extent. A B-lines score denoting the extent and severity of sonographic lesion was calculated by summing the number of B-lines on 18 scanning sites.Results: B-lines (100%), pleural irregularities (25%), consolidation (25%), and pleural effusion (25%) were the main findings of LUS examination. Interstitial abnormalities, ground-glass opacities (GGO), consolidations and local or bilateral patchy shadowing were the main findings of HRCT examination. The findings of LUS and HRCT were compared point to point and high consistency was found between the 2 measurements. A significant correlation was also found between the B-lines score and CT score [r=0.96, 95% confidence interval (CI): 0.81 to 0.99, P=0.0001].Conclusions: Both LUS patterns and B-lines score are significantly correlated with HRCT findings and score, respectively, supporting its role in assessing COVID-19 pneumonia severity, screening, and following up dynamic changes of pneumonia.

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

Cited by 29 publications

References 30 publications

Krebs von den Lungen-6 and surfactant protein-A in interstitial pneumonia with autoimmune features

Krebs von den Lungen-6 and surfactant protein-A in interstitial pneumonia with autoimmune features

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

Lung ultrasound correlates with radiographic severity and pattern in COVID-19 pneumonia: a preliminary study

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