title: A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients.
abstract: OBJECTIVE
  Lung cancer patients with interstitial lung diseases (ILDs) who have undergone pulmonary resection often develop acute exacerbation of interstitial pneumonia (AE) in the post-operative period. To predict who is at high risk of AE, we propose a scoring system that evaluates the risk of AE in lung cancer patients with ILDs.
  
  
  METHODS
  We derived a score for 30-day risk of AE onset after pulmonary resection in lung cancer patients with ILDs (n = 1,022; outcome: risk of AE) based on seven risk factors for AE that were identified in a previous retrospective multi-institutional cohort study. A logistic regression model was employed to develop a risk prediction model for AE.
  
  
  RESULTS
  A risk score (RS) was derived: 5 × (history of AE) + 4 × (surgical procedures) + 4 × (UIP appearance in CT scan) + 3 × (male sex) + 3 × (preoperative steroid use) + 2 × (elevated serum sialylated carbohydrate antigen, KL-6 level) + 1 × (low vital capacity). The RS was shown to be moderately discriminatory with a c-index of 0.709 and accurate with the Hosmer-Lemeshow goodness-of-fit test (p = 0.907). The patients were classified into three groups: low risk (RS: 0-10; predicted probability <0.1; n = 439), intermediate risk (RS: 11-14; predicted probability 0.1-0.25; n = 559), and high risk (RS: 15-22; predicted probability >0.25; n = 24).
  
  
  CONCLUSIONS
  Although further validation and refinement are needed, the risk score can be used in routine clinical practice to identify high risk individuals and to select proper treatment strategies.
authors.affiliation: Department of Thoracic Surgery, Kyoto University, 54 Kawaharacho, Shogoin, Sakyoku, Kyoto, Japan, tsato@kuhp.kyoto-u.ac.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sato
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kondo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.forename: Jun
authors.initials: J
authors.lastname: Nakajima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Niwa
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Horio
authors.forename: Jiro
authors.initials: J
authors.lastname: Okami
authors.forename: Norihito
authors.initials: N
authors.lastname: Okumura
authors.forename: Kenji
authors.initials: K
authors.lastname: Sugio
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kishi
authors.forename: Masahito
authors.initials: M
authors.lastname: Ebina
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sugiyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Kondo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D017563:Lung Diseases, Interstitial / Q000175:diagnosis* / Q000209:etiology; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D013510:Pulmonary Surgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed