AB1456 CLINICAL IMPACT OF THE INTERSTITIAL LUNG DISEASE MULTIDISCIPLINARY SERVICE

Background

Interstitial lung diseases (ILD) are a diverse group of pulmonary diseases for which accurate diagnosis is critical for optimal management and outcomes. Diagnosing ILD, both idiopathic pulmonary fibrosis (IPF) and connective-tissue-disease-associated interstitial lung disease (CTD-ILD), has become critically important, as the disease has a devastating prognosis with poor survival.There are also management implications, as patients with ILD can now potentially be treated with new antifibrotic therapies such as pirfenidone and nintedanib, both of which have been approved. Certain types of CTD – ILD may benefit from systemic immunomodulatory therapies. Diagnosis of ILD can be challenging and a multidisciplinary team (MDT) approach is recommended in current guidelines. Several studies have reported that MDT diagnosis is associated with higher levels of diagnostic confidence and better interobserver agreement (1-3).

Objectives

We describe the benefits of an ILD multidisciplinary service on the diagnosis and management of patients with suspected ILD.

Methods

We performed a single-centre retrospective review of consecutive patients referred to the ILD clinic with subsequent discussions in ILD MDTs over a 36-month period from 2016 to 2019. We compared changes in ILD diagnosis and management at referral to those following the ILD-MDT. We collected data on the demographics, occupation, age at ILD onset, smoking status, imaging, blood tests including autoimmune serology, MDT recommendations, change in diagnosis after MDT, tertiary referral, serial PFTs, medications and outcomes. Cases of suspected ILD that were not fully characterised and those with complex management issues were presented at our monthly ILD MDT.

Results

A total of 208 patients were referred to the ILD clinic over a 36-month period. Of these, 106 cases were discussed at the ILD MDT and the remaining 102 cases did not require discussion at the MDT as these deemed to be clear cut, which included RA and CTD ILD. The mean age of the total cohort was 74 (min age 32, max age 97) and 120 (58 %) were males. Overall, evaluation by the ILD service (i.e. ILD clinic and MDT) resulted in a change in diagnosis in 106(51%) patients. Of those, 49(46%) didn’t have ILD. In the remaining 57 patients with suspected ILD, the majority of the diagnoses were ILD with an uncertain classification (24, 23%). The other diagnoses included CTD-ILD (4, 3.7%), ILD with autoimmune serology 11(10.4%), IPF 10(9.4%), Drug-induced-ILD 3(2.8%), Hypersensitivity Pneumonitis 5(4.7%), Eosinophilic pneumonitis 1 (0.94%), Cryptogenic Pneumonitis 1(0.94%), PPFE with IPF 1 (0.94%), PPFE 1 (0.94%), CPFE 4 (0.94%), EAA 2 (0.94%), RB-ILD 2 (1.88%), Langerhans Histiocytosis 2 (1.88%).16/57(28%) were referred to a tertiary centre for further management. Serology was positive in 11 patients (ANA 6, CCP 3, and ANCA 2). Of the 57 patients with other diagnoses, the main recommendations included steroids (28), anti-fibrotic therapy (4), immunomodulatory therapy (6) and ambulatory Oxygen (1). Further analysis will be carried out on survival and treatment outcomes of the cohort.

Conclusion

Dedicated ILD-MDT service has an important clinical impact on the care of the ILD patient, with frequent changes in ILD diagnosis and subsequent management and outcomes. Multidisciplinary approach to the management of these patients should be standard of care for these patients.

References

[1]Flaherty KR, King TE Jr, Raghu G, et al. Idiopathic interstitial pneumonia: what is the effect of a multidisciplinary approach to diagnosis? Am J Respir Crit Care Med 2004; 170:904-10.

[2]Lynch DA, Sverzellati N, Travis WD, et al. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society White Paper. Lancet Respir Med 2018; 6:138-53.

[3]Ryerson CJ, Corte TJ, Lee JS, et al. A standardized diagnostic ontology for fibrotic interstitial lung disease. An international working group perspective. Am J Respir Crit Care Med 2017; 196:1249-54.

Disclosure of Interests

None declared

In hospital outcomes of orbital/rotational coronary atherectomy in diabetic vs non-diabetic population: insights from the nationwide inpatient sample

Background

Atherectomy (AT) using an orbital/rotational system is useful in altering calcified plaque thereby facilitating stent placement and optimal stent expansion. Patients with diabetes mellitus (DM) are known to have a higher rate of complications after percutaneous coronary intervention. We aimed to assess the incidence of major adverse cardiovascular events after atherectomy in the diabetic population using a nationwide inpatient sample (NIS).

Methods

NIS-HCUP database from 2015–2017 was used to identify patients who underwent atherectomy. A cohort of patients with and without diabetes was identified. Demographics, in-hospital outcomes, complications in both groups were compared. Statistical significance was assigned at p<0.05.

Results

Out of 6184 patients who underwent AT, 3134 (50.6%) patients had DM. Baseline characteristics have been outlined in the table below. Complications were comparable between the two groups except for higher incidence of post-procedure VTE in Diabetic patients. In-hospital mortality was lower among patients with DM (2.24% vs 3.29%, p-0.27), while the mean length of stay (5.92 vs 4.91 days, p-0.002) and the hospitalization charges ($165118.4 vs 151226, p-0.04) were higher, but this difference in length of stay and hospitalization charges were nullified on multivariate regression.

Conclusion

Our study suggests that an AT for severely calcified plaque in the coronary artery is a safe option in patients with DM with comparable in-hospital complications and outcomes to non-DM patients.

Funding Acknowledgement

Type of funding sources: None. Demographics and Outcomes of Atherectomy

C1q nephropathy with acute hemolytic uremic syndrome

C1q nephropathy with hemolytic uremic syndrome (HUS) is an uncommon combination associated with rapidly progressive renal failure. We report a case of C1q nephropathy with HUS in an 18-year-old man associated with rapidly progressive renal failure. The patient did not respond to treatment with steroids and was started on maintenance hemodialysis. C1q nephropathy with HUS is rare and can lead to rapidly progressive renal failure.