Risk factors for mortality in anti-MDA5 antibody-positive dermatomyositis with interstitial lung disease: a systematic review and meta-analysis
Abstract
BACKGROUND: Anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis with interstitial lung disease (MDA5+ DM-ILD) carries a high mortality risk. This meta-analysis aimed to identify mortality risk factors to guide early clinical intervention.
METHODS: Following PRISMA guidelines, we systematically searched PubMed, Embase, Web of Science, and Scopus for studies published before November 18, 2024. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for mortality risk factors. Heterogeneity, sensitivity, and publication bias were assessed using Cochran's Q, one-by-one elimination, and Egger's tests, respectively.
RESULTS: Among 1,153 patients from 15 studies, significant risk factors for mortality included older age (HR = 1.04, 95%CI: 1.03, 1.05), smoking (HR = 1.62, 95%CI: 1.06, 2.47), fever (HR = 2.56, 95%CI: 1.66, 3.95), elevated C-reactive protein (CRP) (HR = 1.02, 95%CI: 1.01, 1.02), rapidly progressive ILD (RP-ILD) (HR = 4.02, 95%CI: 1.89, 8.55), high white blood cell count (WBC) (HR = 1.11, 95%CI: 1.02, 1.21), Krebs von den Lungen-6 (KL-6) (HR = 1.11, 95%CI: 1.06, 1.16), ferritin (≥800 ng/mL) (HR = 6.17, 95%CI: 2.51, 15.20), and lymphocyte count (<1.1×109/L) (HR = 4.88, 95%CI: 1.80, 13.20). Higher PaO2 reduced mortality risk (HR = 0.91, 95%CI: 0.86, 0.98). Male, creatine kinase (CK), percent predicted diffusing capacity of the lung carbon monoxide (DLCO%), percent predicted forced vital capacity (FVC%), and…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 1,153 participants or records.
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