title: Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome.
abstract: OBJECTIVE
  To identify clinical and radiologic findings that affect disease severity and short-term prognosis of humidifier disinfectant-associated lung injury in adults and to compare computed tomography (CT) findings between the patients with and without death or lung transplantation.
  
  
  METHODS
  Fifty-nine adults (mean age, 34 years; M/F = 12:47) were enrolled in this retrospective study. Medical records and prospective surveillance data were used to assess clinical and radiological factors associated with a poor clinical outcome. Multivariate generalized estimating equation models were used to analyse serial CT findings. Overall cumulative major events including lung transplantation and mortality were assessed using the Kaplan-Meier method.
  
  
  RESULTS
  Almost half needed ICU admission (47.5 %) and 17 died (28.8 %). Young age, peripartum and low O2saturation were factors associated with ICU admission. On initial chest radiographs, consolidation (P < 0.001) and ground-glass opacity (P = 0.01) were significantly noted in patients who required ICU admission. CT findings including consolidation (odds ratio (OR), 1.02), pneumomediastinum (OR, 1.66) and pulmonary interstitial emphysema (OR, 1.61) were the risk factors for lung transplantation and mortality.
  
  
  CONCLUSIONS
  Clinical and radiologic findings are related to the risks of lung transplantation and mortality of humidifier disinfectant-associated lung injury. Consolidation, pneumomediastinum and pulmonary interstitial emphysema were short-term prognostic CT findings.
  
  
  CONCLUSIONS
  • Young age, peripartum and low O2saturation were associated with ICU admission. • Consolidation, pneumomediastinum and pulmonary interstitial emphysema were short-term prognostic CT findings. • Consolidation and ground-glass opacity disappeared within 3 months and replaced by centrilobular nodules. • Radiologic findings are related to the outcome of humidifier disinfectant-associated lung injury.
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, South Korea.
authors.forename: Hyun Jung
authors.initials: HJ
authors.lastname: Koo
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, South Korea. dokh@amc.seoul.kr.
authors.forename: Kyung-Hyun
authors.initials: KH
authors.lastname: Do
authors.affiliation: Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, South Korea.
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Chae
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Cancer Center, Seoul, Korea.
authors.forename: Hwa Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Joon Seon
authors.initials: JS
authors.lastname: Song
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Se Jin
authors.initials: SJ
authors.lastname: Jang
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sang-Bum
authors.initials: SB
authors.lastname: Hong
authors.affiliation: Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Huh
authors.affiliation: Department of Pediatrics, Inje University Haundae Paik Hospital, Busan, Korea.
authors.forename: En
authors.initials: E
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, Childhood Asthma and Atopy Center, Environmental Health Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Soo-Jong
authors.initials: SJ
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D004202:Disinfectants / Q000009:adverse effects*; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006801:Humans; D000068998:Humidifiers; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D019570:Inhalation Exposure / Q000009:adverse effects; D053208:Kaplan-Meier Estimate; D055370:Lung Injury / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000628:therapy; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
chemical_list: D004202:Disinfectants
keywords: Adult; Computed tomography; Environmental chemicals; Interstitial lung disease; Prognosis