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      Postoperative acute exacerbation of interstitial pneumonia in pulmonary and non-pulmonary surgery: a retrospective study

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          Abstract

          Background

          Acute exacerbation of interstitial pneumonia (AE-IP) is a serious complication of pulmonary surgery in patients with IP. However, little is known about AE-IP after non-pulmonary surgery. The aim of this study was to determine the frequency of AE-IP after non-pulmonary surgery and identify its risk factors.

          Methods

          One hundred and fifty-one patients with IP who underwent pulmonary surgery and 291 who underwent non-pulmonary surgery were retrospectively investigated.

          Results

          AE-IP developed in 5 (3.3%) of the 151 patients in the pulmonary surgery group and 4 (1.4%) of the 291 in the non-pulmonary surgery group; the difference was not statistically significant. A logistic regression model showed that serum C-reactive protein (CRP) was a predictor of AE-IP in the non-pulmonary surgery group (odds ratio 1.187, 95% confidence interval 1.073–1.344, P = 0.002).

          Conclusions

          This is the first study to compare the frequency of AE-IP after pulmonary surgery with that after non-pulmonary surgery performed under the same conditions. The results suggest that the frequency of AE-IP after non-pulmonary surgery is similar to that after pulmonary surgery. A high preoperative C-reactive protein level is a potential risk factor for AE-IP after non-pulmonary surgery.

          Electronic supplementary material

          The online version of this article (10.1186/s12931-019-1128-5) contains supplementary material, which is available to authorized users.

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          Most cited references26

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          Acute exacerbation of idiopathic pulmonary fibrosis: frequency and clinical features.

          T. Colby, S. H. Kim, J. Park … (2005)
          Although acute exacerbations of idiopathic pulmonary fibrosis are well recognised, there are no studies documenting their prevalence or identifying pre-existing risk factors. This study analysed the clinical, radiological and pathological data of 11 patients who satisfied the criteria for acute exacerbation among 147 patients with biopsy-proven idiopathic pulmonary fibrosis. There were five additional patients who had similar demographics, radiology and surgical lung biopsy pathology, but had clinically less severe disease, and so were not included. The 2-yr frequency of acute exacerbation was 9.6% after the diagnosis. Most exacerbations were idiopathic, although two cases presented after surgical lung biopsy and one after bronchoalveolar lavage. No significant risk factor was found by univariate proportional hazard analysis. Imaging revealed diffuse bilateral ground-glass opacification superimposed on subpleural reticular and honeycombing densities. The biopsies of four patients taken during acute exacerbation exhibited diffuse alveolar damage superimposed upon usual interstitial pneumonia. The findings of this study demonstrate that acute exacerbation of idiopathic pulmonary fibrosis is rather common and this exacerbation is likely to have a spectrum of severity.
          Article 0 comments Cited 126 times – based on 0 reviews     Review now
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            Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer.

            Kazuhiko Kataoka, Yukihiko Sugiyama, Takashi KONDO … (2014)
            The study objective was to examine the incidence, risk factors, and mortality rate of acute exacerbation of interstitial lung diseases in patients with lung cancer undergoing pulmonary resection in a large-scale multi-institutional cohort.
            Article 0 comments Cited 96 times – based on 0 reviews     Review now
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              Herpesvirus DNA is consistently detected in lungs of patients with idiopathic pulmonary fibrosis.

              Y.-W. Tang, J. Johnson, P. J. Browning … (2003)
              On the basis of earlier reports associating Epstein-Barr Virus (EBV) with half of the cases of idiopathic pulmonary fibrosis (IPF), we hypothesized that chronic infection with EBV or a closely related herpesvirus would be detected in all cases of IPF. We tested lung specimens from 33 IPF patients (8 patients with familial IPF and 25 patients with sporadic IPF) and 25 patients with other diseases as controls for the presence of eight herpesviruses using PCR-based techniques. One or more of four herpesviruses (cytomegalovirus [CMV], EBV, human herpesvirus 7 [HHV-7], and HHV-8) were detected in 32 of 33 (97%) subjects with IPF and in 9 of 25 (36%) controls (P < 0.0001). CMV, EBV, and HHV-8 were found more frequently in IPF patients than in controls (P < 0.05, P < 0.001, and P < 0.01 respectively). Two or more herpesviruses were detected in 19 of 33 (57%) IPF patients and in 2 of 25 (8%) controls (P < 0.001). Two or more herpesviruses and HHV-8 were found more frequently in patients with sporadic IPF than in patients with familial IPF (P < 0.05 for both comparisons), and CMV was found less frequently in patients with sporadic IPF than in patients with familial IPF (P < 0.05). Immunohistochemistry for EBV or HHV-8 antigen showed viral antigen primarily in airway epithelial cells. These data support the concept that a herpesvirus could be a source of chronic antigenic stimulation in IPF.
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                Author and article information

                Contributors
                Takuto Miyamura: t-miyamura@nagasaki-u.ac.jp
                Noriho Sakamoto:
                ORCID: http://orcid.org/0000-0002-7577-476X
                nsakamot@nagasaki-u.ac.jp
                Tomoyuki Kakugawa: tomoyukikakugawa@gmail.com
                Daisuke Okuno: vkvkv10101@gmail.com
                Hirokazu Yura: h_yura.5994@me.com
                Shota Nakashima: shonaka@nagasaki-u.ac.jp
                Hiroshi Ishimoto: h-ishimoto@nagasaki-u.ac.jp
                Takashi Kido: t-kido@nagasaki-u.ac.jp
                Daisuke Taniguchi: dt_dt0729@hotmail.com
                Takuro Miyazaki: miyataku@nagasaki-u.ac.jp
                Tomoshi Tsuchiya: tomoshi@nagasaki-u.ac.jp
                Shin Tsutsui: s-tsutsui@nagasaki-u.ac.jp
                Hiroyuki Yamaguchi: yamaguchi-hiroyuki@umin.ac.jp
                Yasushi Obase: obaseya@nagasaki-u.ac.jp
                Yuji Ishimatsu: yuji-i@nagasaki-u.ac.jp
                Kazuto Ashizawa: ashi@nagasaki-u.ac.jp
                Takeshi Nagayasu: nagayasu@nagasaki-u.ac.jp
                Hiroshi Mukae: hmukae@nagasaki-u.ac.jp
                Journal
                Journal ID (nlm-ta): Respir Res
                Journal ID (iso-abbrev): Respir. Res
                Title: Respiratory Research
                Publisher: BioMed Central (London )
                ISSN (Print): 1465-9921
                ISSN (Electronic): 1465-993X
                Publication date (Electronic): 15 July 2019
                Publication date PMC-release: 15 July 2019
                Publication date (Print): 2019
                Volume: 20
                Electronic Location Identifier: 154
                Affiliations
                [1 ]ISNI 0000 0000 8902 2273, GRID grid.174567.6, Department of Respiratory Medicine, , Nagasaki University Graduate School of Biomedical Sciences, ; 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
                [2 ]ISNI 0000 0000 8902 2273, GRID grid.174567.6, Department of Surgical Oncology, , Nagasaki University Graduate School of Biomedical Sciences, ; 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
                [3 ]ISNI 0000 0000 8902 2273, GRID grid.174567.6, Department of Nursing, , Nagasaki University Graduate School of Biomedical Sciences, ; 1-7-1 Sakamoto, Nagasaki, 852-8520 Japan
                [4 ]ISNI 0000 0000 8902 2273, GRID grid.174567.6, Department of Clinical Oncology, , Nagasaki University Graduate School of Biomedical Sciences, ; 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan
                Author information
                http://orcid.org/0000-0002-7577-476X
                Article
                Publisher ID: 1128
                DOI: 10.1186/s12931-019-1128-5
                PMC ID: 6631983
                PubMed ID: 31307466
                SO-VID: 1e44a0cb-0eb6-4b6f-9b66-03ff3d1f74d5
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 6 November 2018
                Date accepted : 8 July 2019
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Respiratory medicine
                Keywords: acute exacerbation,c-reactive protein,interstitial pneumonia,surgery
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: acute exacerbation, c-reactive protein, interstitial pneumonia, surgery

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