Multidisciplinary Discussion for Fibrotic Hypersensitivity Pneumonitis with a Positive Antigen Avoidance

Figures & data

Figure 1 Flowchart showing patient inclusion criteria.

Abbreviations: fHP, fibrotic hypersensitivity pneumonitis; MDD, multidisciplinary discussion; AAT, antigen avoidance test.

Table 1 Baseline Characteristics

	fHP with MDD	Clinical fHP	p values
Subjects	37	21
Age (yrs)	72 (69‒75)	72 (67‒76)	0.85
Sex (male/female), n	20/17	15/6	0.27
Smoking history, n	16 (43%)	6 (29%)	0.40
Body mass index	23.0 (21.6‒24.1)	23.1 (20.7‒26.5)	0.58
Surgical lung biopsy/transbronchial lung cryobiopsy, n	18/19	0/0
White blood cell counts (/μL)	6200 (5230‒8100)	7730 (6670‒8530)	0.03
C-reactive protein (mg/dL)	0.14 (0.07‒0.28)	0.53 (0.13‒2.32)	0.047
Serum Krebs von den Lungen-6 (U/mL)	2030 (1040‒2650)	2190 (850‒3110)	0.72
Partial pressure of arterial oxygen (Torr)	80 (72‒87)	74 (66‒84)	0.34
FVC %pred.	78 (64‒94)	78 (68‒93)	0.86
DLco %pred.	63 (53‒76)	71 (46‒90)	0.37
Lymphocytes in bronchoalveolar lavage (%)	43 (19‒66) n = 35	37 (10‒56) n = 11	0.18
Diagnostic confidence (definite/high/moderate/low confidence), n	23/4/10/0	n/a
HRCT pattern (typical for fHP/compatible with fHP/indeterminate for fHP), n	8/26/3	6/13/2	0.80
Disease progression within 3 months prior to AAT, n	17 (46%)	18 (86%)	0.005

Notes: Data are presented as median (interquartile range) or n. The reference ranges of Krebs von den Lungen-6 is 0–499U/mL.

Abbreviations: fHP, fibrotic hypersensitivity pneumonitis; MDD, multidisciplinary discussion; FVC, forced vital capacity; %pred: % predicted; DLco, diffusion capacity of the lung for carbon monoxide; HRCT, high-resolution CT; AAT, antigen avoidance test.

Table 2 Annual Changes

Parameters	fHP with MDD	Clinical fHP	p values
delta FVC, %	0.9 (−6.5‒9.9) n =31	−2.1 (−9.5‒2.9) n = 14	0.41
delta DLco, %	0.9 (−3.8‒8.8) n = 27	5.1 (−12.9‒18.1) n = 13	0.79
delta KL-6, %	−30 (−48‒4) n = 31	−32 (−54‒29) n =19	0.81
delta CRP (mg/dL)	0.01 (−0.05‒0.10) n = 36	−0.04 (−0.44‒0.05) n = 21	0.08

Notes: Data are presented as median (interquartile range).

Abbreviations: fHP, fibrotic hypersensitivity pneumonitis; MDD, multidisciplinary discussion; FVC, forced vital capacity; DLco, diffusion capacity of the lung for carbon monoxide; KL-6, Krebs von den Lungen-6; CRP, C-reactive protein.

Table 3 Cox Hazard Regression Analysis for Overall Survival

Variables	Level	Univariate p	HR (95% CI)	Multivariate P
Age	≥72 vs <72 (ref.)	0.68
Smoking history	Others vs Never (ref.)	0.73
White blood cell counts	≥7000 vs <7000 (ref.)	0.05	2.19 (0.97‒4.94)	0.058
Serum Krebs von den Lungen-6 (U/mL)	≥2000 vs <2000 (ref.)	0.55
Forced vital capacity (%)	<79 vs ≥79 (ref.)	0.037	2.55 (1.08‒5.99)	0.032
C-reactive protein	≥0.18 vs <0.18 (ref.)	0.47
Disease progression within 3 months prior to AAT	Yes vs No (ref.)	0.22
Conducting MDD	No vs Yes (ref.)	0.48	1.58 (0.68‒3.64)	0.287

Abbreviations: HR, hazard ratio; CI, confidence interval; AAT, AAT; MDD, multidisciplinary discussion; ref, reference.

Figure 2 Overall survival in MDD diagnosis and clinical diagnosis groups.

Abbreviations: MDD, multidisciplinary discussion; HR, hazard ratio; CI, confidence interval.