Development Of A Scoring System With Multidimensional Markers For Fibrosing Interstitial Lung Disease

Fibrosing interstitial lung disease (ILD) can cause high mortality and sensitive evaluation of fibrosing ILD could be critical. The aim of this study is to develop a scoring system to predict prognosis of fibrosing ILD. We retrospectively reviewed 339 fibrosing ILD patients admitted to Nanjing Drum Tower Hospital from February 2017 to February 2020. All patients were followed up until September 2020. Cox multiple regression analysis indicated that smoking history (HR=3.826, P=0.001),age(HR=1.043,P=0.015),CEA(HR=1.059,P=0.049),CYFRA21-1(HR=1.177, P=0.004) and DLCO% predicted (HR=0.979,P=0.032) were independent prognostic factors for fibrosing ILD. The clinical scoring system for fibrosing ILD was established based on the clinical variables (age [A], CEA and CYFRA21-1 [C], DLCO% predicted [D], and smoking history [S]; ACDS). The area under the receiver operating characteristic curve (AUROC) of the scoring system for predicting prognosis of fibrosing ILD was 0.91 (95%CI: 0.87-0.94, P<0.001). The cutoff value was 2.5 with their corresponding specificity (91.1%) and sensitivity (77.5%). Correlation analyses showed that the increased age, CEA and CYFRA21-1 were significantly correlated with decreased DLCO%predicted (P<0.001, P=0.028, P<0.001, respectively). The independent risk factors for mortality in patients with fibrosing ILD are higher CEA, higher CYFRA21-1, smoking history, lower DLCO%predicted at baseline and older age. ACDS is a simple and feasible clinical model for predicting survival of fibrosing ILD.