title: Pulmonary infections following immunosuppressive treatments during hospitalization worsen the short-term vital prognosis for patients with connective tissue disease-associated interstitial pneumonia.
abstract: OBJECTIVE
  Connective tissue disease-associated interstitial pneumonia (CTD-IP) significantly affects the mortality of patients with CTD. The purpose of the present study is to identify causes and risk factors for death during hospitalization for immunosuppressive treatment of CTD-IP.
  
  
  METHODS
  A multicenter, retrospective study was conducted that collected data from patients with CTD who had been hospitalized for commencing or intensifying immunosuppressive treatment of CTD-IP using a standardized case report form. Risk factors were identified using the Cox proportional hazard regression model.
  
  
  RESULTS
  A total of 322 CTD-IP patients were enrolled with rheumatoid arthritis (n = 84), systemic lupus erythematosus (n = 13), polymyositis (n = 33), dermatomyositis (n = 69), systemic sclerosis (n = 55), mixed connective tissue disease (n = 21), microscopic polyangiitis (n = 19), and overlap syndrome (n = 28). Of the 42 patients who died during hospitalization, 22 died from CTD-IP, 15 from CTD-IP and pulmonary infection, 2 from pulmonary infection, and 3 from other causes. Age ≥ 65 years and development of pulmonary infections after commencing or intensifying immunosuppressive treatments were identified as risk factors for death during hospitalization after adjusting for covariates.
  
  
  CONCLUSIONS
  Careful consideration of the benefit-risk balance of immunosuppressive treatment for CTD-IP is indispensable for improving the short-term vital prognosis of these patients.
authors.affiliation: Department of Pharmacovigilance, Graduate School of Medical and Dental Sciences, Tokyo Medical Dental University , Bunkyo-ku, Tokyo , Japan.
authors.forename: Michi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Ryuji
authors.initials: R
authors.lastname: Koike
authors.forename: Ryoko
authors.initials: R
authors.lastname: Sakai
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Saito
authors.forename: Shintaro
authors.initials: S
authors.lastname: Hirata
authors.forename: Hayato
authors.initials: H
authors.lastname: Nagasawa
authors.forename: Hideto
authors.initials: H
authors.lastname: Kameda
authors.forename: Masako
authors.initials: M
authors.lastname: Hara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Shigeto
authors.initials: S
authors.lastname: Tohma
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Takasaki
authors.forename: Makoto
authors.initials: M
authors.lastname: Dohi
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nishioka
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Yasuda
authors.forename: Yasunari
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Yuko
authors.initials: Y
authors.lastname: Kaneko
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nanki
authors.forename: Kaori
authors.initials: K
authors.lastname: Watanabe
authors.forename: Hayato
authors.initials: H
authors.lastname: Yamazaki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Miyasaka
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Harigai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003240:Connective Tissue Diseases / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D017563:Lung Diseases, Interstitial / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012141:Respiratory Tract Infections / Q000139:chemically induced* / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents
keywords: Connective tissue disease; Immunosuppressive treatments; Interstitial; Pulmonary infections; Vital prognosis; pneumonia