The Diagnostic Contribution of Systematic Lung Ultrasonography in Patients Admitted to a Conventional Pulmonology Hospitalization Unit.

OBJECTIVE: Although the evidence to date remains limited, we hypothesized that performing protocolized lung ultrasound (LUS) in patients, admitted to a conventional pulmonology hospitalization unit, could improve diagnostic precision. The main objectives of this study were to evaluate the diagnostic contribution and changes in the treatments administered after performing a protocolized LUS in patients hospitalized in a Pulmonology Department ward. METHODOLOGY: This was a prospective, observational study, which included patients admitted from the Emergency Department to a conventional Pulmonology Department hospitalization unit, after first being evaluated by a pulmonologist. LUS was performed within the first 48 hours of admission. The diagnosis at the time of discharge was used as the reference diagnosis. RESULTS: A total of 180 patients were included in this study. The admitting diagnoses were the decompensation of an underlying obstructive disease in 60 patients (33.3%), respiratory infection in 93 (51.7%), pulmonary thromboembolism (PE) in 9 (5%), exacerbation of an interstitial lung disease in 14 (7.8%), and other causes in 4 cases (2.2%). Ultrasonography provided new information, unsuspected at the patient's admission, in 117 (65%) of the patients by capturing images suggestive of infection in 63 patients (35%), 1 new case of ILD, 23 (12.7%) cases of cardiogenic edema, and pleural pathology in 19 (10.5%), as well as two tumors and indirect data related to a PE. The use of LUS resulted in the decision to change the already established treatment in 17.2% of the cases. CONCLUSIONS: LUS provided additive information in more than half of patients that ended up reclassifying or potentially changing diagnosis or treatment. Thus, including LUS in management algorithms could reduce the need for other complementary tests or unnecessary treatments.

Prevalence and clinical impact of systemic autoimmune rheumatic disease in patients with silicosis / Prevalencia e impacto clínico de las enfermedades reumatológicas autoinmunitarias sistémicas en pacientes con silicosis

Background: Silicosis is associated with an increased risk of developing systemic autoimmune rheumatic disease (SARD). The prognostic implications of this association are poorly characterized. The aim of this study was to determine the prevalence of SARD and autoimmune markers in a cohort of patients with exposure to silica and assess their impact on prognosis. Method: We performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed. Results: Overall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0% vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030). Conclusions: The presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact. (AU)

Introducción: La silicosis se asocia a un aumento del riesgo de padecer una de las enfermedades reumatológicas autoinmunes sistémicas (ERAS), aunque no se conocen las implicaciones clínicas de esta asociación. El objetivo del estudio es determinar la prevalencia de ERAS y de marcadores de autoinmunidad en una cohorte de pacientes con exposición a inhalación de polvo de sílice y evaluar su impacto clínico. Método: Estudio observacional prospectivo en pacientes atendidos en una consulta monográfica de silicosis desde 2009 hasta diciembre 2017. El diagnóstico de ERAS se confirmó por un especialista en Reumatología según criterios de la Sociedad Española de Reumatología. Se analizaron marcadores de autoinmunidad, pruebas de función respiaratoria, progresión radiológica e impacto clínico medido por visitas a Atención Primaria, a Servicio de Urgencias, ingresos hospitalarios por causa respiratoria y mortalidad. Resultados: Se estudiaron 489 casos de silicosis y 95 de exposición a inhalación de polvo de sílice sin silicosis. De los pacientes con silicosis, 54 (11,0%) tenían ERAS: 12 (2,4%) artritis reumatoide, 10 (2,0%) lupus eritematoso sistémico, 10 (2,0%) esclerosis sistémica, 6 (1,2%) artritis psoriásica, 3 (0,6%) Síndrome de Sjögren, 2 (0,4%) vasculitis asociada a anticuerpos anticitoplasma de neutrófilos, 3 (0,6%) espondiloartritis y 8 (1,6%) enfermedad autoinmune sin características específicas. Los pacientes con ERAS realizaron más visitas a urgencias (63,0% vs. 42,5%; p = 0,004), y experimentaron mayor progresión (22,2 vs. 11,7%; p = 0,030). Conclusiones: Los pacientes con silicosis presentan una prevalencia de ERAS elevada y su presencia se asocia a una mayor progresión radiológica y un mayor impacto clínico. (AU)

Serum levels of inflammatory mediators as prognostic biomarker in silica exposed workers.

Silicosis is a diffuse interstitial lung disease caused by sustained inhalation of silica and silicates. Several cytokines are activated by their inhalation and can mediate the process of pulmonary fibrosis. The identification of biomarkers could allow an early diagnosis before the development of radiological alterations and help monitor the evolution of patients. The objetive of this study was to determine the clinical significance of specific biomarkers, to estimate their association with the development, severity and/or progression of silicosis, and identify determinants of this evolution. We conducted a prospective observational study in patients attending the pulmonology clinic from 2009 to 2018. Serum levels of the following inflammatory mediators were assessed: interleukin-6 (IL-6), interleukin 2 receptor subunit alpha (IL2R) interleukin 1 beta (IL1B), interleukin-8 (IL-8), tumour necrosis factor-alpha (TNF-α), transforming growth factor-beta1 (TGF-ß1), alpha-1 antitrypsin (AAT), C-reactive protein (CRP), lactate dehydrogenase (LDH) and ferritin in subjects exposed to silica, with and without silicosis. Association between those inflammatory mediators with lung function measurements and radiological severity of disease and their impact on prognosis were analysed. 337 exposed to silica (278 with silicosis) and 30 subjects in the control group were included. IL-8, α1AT, ferritin, CRP and LDH levels were higher in silicosis than in those exposed to silica without silicosis. IL-8, LDH and AAT levels were associated with progression of silicosis and IL-6, IL-8, LDH, AAT, ferritin, and CRP with vital status. The results of the ROC analysis indicated the potential of IL-8 as a biomarker in the presence of silicosis and for the prediction of mortality.

Prevalence and clinical impact of systemic autoimmune rheumatic disease in patients with silicosis.

BACKGROUND: Silicosis is associated with an increased risk of developing systemic autoimmune rheumatic disease (SARD). The prognostic implications of this association are poorly characterized. The aim of this study was to determine the prevalence of SARD and autoimmune markers in a cohort of patients with exposure to silica and assess their impact on prognosis. METHOD: We performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed. RESULTS: Overall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0% vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030). CONCLUSIONS: The presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact.

Prevalence and Clinical Impact of Systemic Autoimmune Rheumatic Disease in Patients with Silicosis. / Prevalencia e impacto clínico de las enfermedades reumatológicas autoinmunitarias sistémicas en pacientes con silicosis.

BACKGROUND: Silicosis is associated with an increased risk of developing systemic autoimmune rheumatic disease (SARD). The prognostic implications of this association are poorly characterized. The aim of this study was to determine the prevalence of SARD and autoimmune markers in a cohort of patients with exposure to silica and assess their impact on prognosis. METHOD: We performed a prospective observational study of all patients attending the dedicated silicosis clinic of our pulmonology unit between 2009 and December 2017. Diagnosis was confirmed by a rheumatologist according to Spanish Rheumatology Society criteria. Autoimmune markers, pulmonary function tests, radiological progression, visits to the emergency department and primary care center, and hospital admissions for respiratory causes, and mortality were analyzed. RESULTS: Overall, 489 cases of silicosis and 95 cases of exposure were studied. In total, 54 (11.0%) patients with silicosis had SARD: 12 (2.4%) rheumatoid arthritis, 10 (2.0%) systemic lupus erythematosus, 10 (2.0%) systemic sclerosis, 3 (0.6%) Sjögren syndrome, 2 (0.4%) vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA +), 6 (1.2%) psoriatic arthritis, 3 (0.6%) ankylosing spondylitis, and 8 (1.6%) other autoimmune diseases with no special features. The patients with SARD visited the emergency room more often (63.0 vs. 42.5%; p = 0.004), and progressed more rapidly (22.2 vs. 11.7%; p = 0.030). CONCLUSIONS: The presence of systemic rheumatic autoimmune diseases involves radiological progression and a higher clinical impact.

La prueba de la marcha de 6 minutos como factor pronóstico y de capacidad de ejercicio en pacientes con silicosis / The 6-Minute Walk Test as a Tool for Determining Exercise Capacity and Prognosis in Patients with Silicosis

Objetivo: Evaluar la capacidad de ejercicio, utilizando la prueba de la marcha de 6 minutos (6MWT), en pacientes con silicosis complicada, e identificar factores relacionados con dicho resultado, así como su valor pronóstico de hospitalización y mortalidad. Método: Estudio observacional prospectivo en 143 pacientes diagnosticados de silicosis complicada atendidos en consulta de neumología desde 2009 hasta diciembre 2016, sin limitación para hacer la 6MWT. Se evaluaron las pruebas de función pulmonar, los hallazgos de la tomografía computarizada y los parámetros de la 6MWT (distancia caminada y desaturación de oxígeno). Resultados: Los pacientes con silicosis complicada caminaban una media de 387 ± 92m. Los resultados fueron peores al aumentar la gravedad de la enfermedad; en silicosis A: 407 ± 97; B: 370 ± 88, y C: 357 ± 68 (p=0,022). La 6MWT mostraba una correlación positiva con la función pulmonar e inversa con la disnea (p < 0,001). Los pacientes con enfisema moderado/severo y un mayor tiempo con saturación nocturna de oxígeno por debajo del 90% presentaban resultados significativamente peores en la 6MWT. Los pacientes que caminaban < 350 m tenían más hospitalizaciones (3,7 ± 4,0) que los que caminaban>350 (1,1 ± 2,9). Los fallecidos al final del seguimiento caminaron 327,9 ± 73,0 frente a los que sobreviven, que caminaron 404,5 ± 89,7 m (p < 0,001). Conclusiones: Los valores de la espirometría y la categoría de la silicosis se relacionan con el resultado de la 6MWT, que resultó ser factor pronóstico para hospitalización y mortalidad. La 6MWT se perfila como una herramienta útil en salud ocupacional para el seguimiento de pacientes con silicosis

Objective: To evaluate exercise capacity using the 6-minute walk test (6MWT) in patients with complicated silicosis, and to determine how results shape the prognostic value of 6MWT for hospitalization and mortality. Method: Prospective observational study in 143 patients with complicated silicosis who performed the 6MWT in our outpatient pulmonology clinic between 2009 and the end of 2016. Lung function tests, computed tomography findings and 6MWT parameters (distance walked and oxygen desaturation) were evaluated. Results: Patients with complicated silicosis walked 387±92m. Results deteriorated as silicosis severity increased; category A: 407 ± 97m, B: 370±88m, and C: 357 ± 68m (P=.022). The 6MWT correlated positively with lung function and inversely with dyspnea determined by mMRC (P < .001). Patients with moderate/severe emphysema and greater CT90 presented a worse result on 6MWT. Patients who walked < 350m had more hospitalizations (3.7 ± 4.0) than those who walked > 350m (1.1 ± 2.9). There was an impact on survival: non-survivors walked 327.9 ± 73.0m, while survivors walked 404.5 ± 89.7m (P < .001). Conclusions: Spirometry values and category of complicated silicosis correlated with 6MWT and distance walked was a prognostic factor for hospitalization and mortality. The 6MWT is a useful tool in occupational health for monitoring patients with silicosis

The 6-Minute Walk Test as a Tool for Determining Exercise Capacity and Prognosis in Patients with Silicosis. / La prueba de la marcha de 6 minutos como factor pronóstico y de capacidad de ejercicio en pacientes con silicosis.

OBJECTIVE: To evaluate exercise capacity using the 6-minute walk test (6MWT) in patients with complicated silicosis, and to determine how results shape the prognostic value of 6MWT for hospitalization and mortality. METHOD: Prospective observational study in 143 patients with complicated silicosis who performed the 6MWT in our outpatient pulmonology clinic between 2009 and the end of 2016. Lung function tests, computed tomography findings and 6MWT parameters (distance walked and oxygen desaturation) were evaluated. RESULTS: Patients with complicated silicosis walked 387±92m. Results deteriorated as silicosis severity increased; category A: 407±97m, B: 370±88m, and C: 357±68m (P=.022). The 6MWT correlated positively with lung function and inversely with dyspnea determined by mMRC (P<.001). Patients with moderate/severe emphysema and greater CT90 presented a worse result on 6MWT. Patients who walked<350m had more hospitalizations (3.7±4.0) than those who walked>350m (1.1±2.9). There was an impact on survival: non-survivors walked 327.9±73.0m, while survivors walked 404.5±89.7m (P<.001). CONCLUSIONS: Spirometry values and category of complicated silicosis correlated with 6MWT and distance walked was a prognostic factor for hospitalization and mortality. The 6MWT is a useful tool in occupational health for monitoring patients with silicosis.