Study On Early Warning Role Of Bilirubin And Age In The Progressive Exacerbations Of Fibrotic Interstitial Lung Disease

Objective:With the aging of our country,the incidence of interstitial lung diseases(ILD)is increasing year by year,as a chronic inflammation of the lungs,the disease is generally chronic,but most patients will have progressive exacerbations during the course of the disease,if not clinically intervened in the early stage of progression,it will often lead to irreversible fibrotic changes in lung tissue,further deterioration of lung function,and serious adverse effects on the quality of life of patients.Unlike acute exacerbations caused by infection,progressive pulmonary fibrosis lacks specific clinical manifestations,it is difficult to detect early,and irreversible pulmonary fibrosis changes often had occured by the time patients present to the doctor,and it is too late to treat them,so it is important to explore whether there are readily available predictors when the patient’s pulmonary fibrosis is progressive exacerbated,so that we can detect the patient’s disease progression early.Oxidative stress is considered to be an important molecular mechanism of various organ fibrosis,and studies have confirmed that bilirubin is related to pulmonary fibrosis caused by oxidative stress,but there are no relevant studies in China on whether it has an early warning effect on disease progression,and the prevalence and incidence of ILD increase with age,which is also a recognized risk factor,but it is unclear whether it is related to disease progression.This study analyzes the early predictors of progressive worsening of pulmonary fibrosis in patients with fibrosing interstitial lung diseases(FILD),which enables us to detect the progression of patients early,provide early intervention treatment,and improve patients’ prognosis.Methods:In this study,120 patients with FILD who were hospitalized in the First Affiliated Hospital of Anhui Medical University from January 2019 to December 2022 were collected,and patients with worsening respiratory symptoms,lung function or imaging progression in the past year were classified as progression group(see methods for details),and the rest were included in the stable group,including 57 cases in the progressive group and 63 cases in the stable group.The general information of the patients was collected,including age,sex,and body mass index;clinical manifestations include cough,sputum production,and shortness of breath;blood test results such as white blood cell count,hemoglobin,red blood cell distribution width,platelet count,albumin,total bilirubin,direct bilirubin,indirect bilirubin,etc.;chest CT,cardiac ultrasound results and other clinical data.Univariate analysis and multivariate logistics regression were used to analyze the factors related to the progression of patients with FILD;The ROC curve was used to assess the predictive value of age for progression or exacerbations in patients with FILD;Spearson correlation was used to analyze the relationship between age,bilirubin and pulmonary fibrosis score.Results:Among the 120 patients with common FILD,the age distribution of the progressive group was between(58.5-73.0)years,the male group was dominated(30 cases,52.6%),the age distribution of the stable group was between(50.0-61.0)years,and the male was the main(50 cases,79.4%),and cough and shortness of breath were more common in the progressive group.Univariate analysis showed that the pulmonary artery pressure,PLT,and levels in the progressive group were higher than those in the stable group,and the differences were statistically significant((49)<0.05).The levels of ALB,HB,TBIL,DBIL and IBIL in the progressive group were lower than those in the stable group,and the difference was statistically significant((49)<0.05).Multivariate logistics regression analysis showed that age(OR=0.906,(49)=0.009,95% CI: 0.842-0.976),direct bilirubin(OR=4.101,(49)=0.001,95%CI: 1.823-9.229),indirect bilirubin(OR=3.152,(49)=0.001,95% CI: 1.604-6.195)were associated with disease progression in patients with FILD.The predictive value of direct bilirubin and indirect bilirubin for acute exacerbation of FILD was 0.757((49)=0.001)and the optimal cut-off value was 61.5 years,and the area under the curve of direct bilirubin was 0.857((49)=0.001),and the optimal cut-off value was 3.15μmol/L.The area under the curve of indirect bilirubin was 0.916((49)=0.001),and the optimal cut-off value was 6.05 μ mol/L.The results of Spearson correlation analysis showed that age was positively correlated with pulmonary fibrosis score,and direct bilirubin and indirect bilirubin were negatively correlated with pulmonary fibrosis score.Conclusion:1.Compared with the stable group,the proportion of men was higher in the progressive group was higher,and the incidence of cough and shortness of breath was higher,and the image manifestations of ground glass shadow,grid shadow,irregular thickening of lobular interval,and honeycomb shadow were more common in the progressive group;2.The serum bilirubin level of FILD patients in the progressive group was lower than that in the stable group,and when the direct bilirubin was less than 3.15μmol/L or the indirect bilirubin was less than 6.05μmol/L,it indicated that the risk of progressive exacerbation was increased,and the level of direct bilirubin and indirect bilirubin was negatively correlated with the severity of pulmonary fibrosis;3.The age of patients with FILD in the progressive group was higher than that in the stable group,and when the age was greater than 61.5 years,it indicated that the risk of progressive exacerbation was increased,and the age was positively correlated with the severity of pulmonary fibrosis.