Humidifier disinfectant-associated lung injury in adults: Prognostic factors in predicting short-term outcome
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To identify clinical and radiologic findings that affect disease severity and short-term prognosis of humidifier disinfectant-associated lung injury in adults and to compare computed tomography (CT) findings between the patients with and without death or lung transplantation.
Fifty-nine adults (mean age, 34 years; M/F = 12:47) were enrolled in this retrospective study. Medical records and prospective surveillance data were used to assess clinical and radiological factors associated with a poor clinical outcome. Multivariate generalized estimating equation models were used to analyse serial CT findings. Overall cumulative major events including lung transplantation and mortality were assessed using the Kaplan–Meier method.
Almost half needed ICU admission (47.5 %) and 17 died (28.8 %). Young age, peripartum and low O2 saturation were factors associated with ICU admission. On initial chest radiographs, consolidation (P < 0.001) and ground-glass opacity (P = 0.01) were significantly noted in patients who required ICU admission. CT findings including consolidation (odds ratio (OR), 1.02), pneumomediastinum (OR, 1.66) and pulmonary interstitial emphysema (OR, 1.61) were the risk factors for lung transplantation and mortality.
Clinical and radiologic findings are related to the risks of lung transplantation and mortality of humidifier disinfectant-associated lung injury. Consolidation, pneumomediastinum and pulmonary interstitial emphysema were short-term prognostic CT findings.
• Young age, peripartum and low O 2 saturation were associated with ICU admission.
• Consolidation, pneumomediastinum and pulmonary interstitial emphysema were short-term prognostic CT findings.
• Consolidation and ground-glass opacity disappeared within 3 months and replaced by centrilobular nodules.
• Radiologic findings are related to the outcome of humidifier disinfectant-associated lung injury.
KeywordsAdult Interstitial lung disease Environmental chemicals Computed tomography Prognosis
acute respiratory distress syndrome
cryptogenic organizing pneumonia
intensive care unit
The authors would like to thank all of the patients who participated in this study. We also thank the members of Humidifier Disinfectant Interstitial Lung Disease Surveillance and Research Team including the pulmonologists, pathologists and radiologists in our institution for their valuable help.
The scientific guarantor of this publication is Kyung-Hyun Do. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This research was supported by the Environmental Health Center for Hazardous Chemical Exposure funded by the Ministry of Environment (2015-0510), Republic of Korea. One of the authors (Hwa Jung Kim) has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.
Seventeen patients from this were previously described (Hong S.B. et al. Thorax 69(8):694–702, 2014), as mentioned in the “Materials and methods” of this manuscript. Methodology: retrospective, observational, multicentre study.
- 1.Cheon CK, Jin HS, Kang EK et al (2008) Epidemic acute interstitial pneumonia in children occurred during the early 2006s. Kor J Pediatr 51:383–390Google Scholar
- 2.Kim BJ, Kim HA, Song YH et al (2009) Nationwide surveillance of acute interstitial pneumonia in korea. Kor J Pediatr 52:324–329Google Scholar
- 4.Lee JH, Kim YH, Kwon JH (2012) Fatal misuse of humidifier disinfectants in Korea: importance of screening risk assessment and implications for management of chemicals in consumer products. Environ Sci Technol 46:2498–2500Google Scholar
- 5.Ohnuma A, Yoshida T, Tajima H et al (2010) Didecyldimethylammonium chloride induces pulmonary inflammation and fibrosis in mice. Exp Toxicol Pathol 62:643–651Google Scholar
- 6.Korea Centers for Disease Control and Prevention (2011) Interim report of epidemiological investigation on lung injury with unknown cause in Korea. Public Health Wkly Rep 4:817–825Google Scholar