• Shota Okamoto, Hiroto Tsuboi, Hisashi Noma, Daiki Tabuchi, Toshiki Sugita, Taihei Nishiyama, Toshihiko Terasaki, Masaru Shimizu, Fumika Honda, Mizuki Yagishita, Ayako Ohyama, Izumi Kurata, Saori Abe, Hiroyuki Takahashi, Atsumu Osada, Shinya Hagiwara, Yuya Kondo, Isao Matsumoto, and Takayuki Sumida.
• Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Japan.
• Intern. Med. 2021 Jan 1; 60 (18): 2887-2897.

AbstractObjective To identify factors associated with pneumomediastinum during management of connective tissue disease (CTD)-related interstitial lung disease (ILD). Methods Patients diagnosed with pneumomediastinum after the initiation of corticosteroid therapy for their CTD-ILD were enrolled. The baseline characteristics of patients who developed pneumomediastinum after the initiation of corticosteroid therapy (n=13, all occurring within 120 days) were compared to those of patients who did not develop pneumomediastinum (n=49). A multivariate logistic regression analysis was performed to identify factors associated with pneumomediastinum. A receiver operating characteristic (ROC) curve analysis was also performed to assess the predictive performance. Results The body mass index (BMI) [odds ratio (OR) (95% confidence interval (CI)) 0.482 (0.272-0.853)] and serum lactate dehydrogenase (LDH) [OR (95% CI) 1.013 (1-1.025)] levels at baseline were identified as independent factors associated with pneumomediastinum after corticosteroid initiation. The optimal cut-off points of the BMI and LDH levels for predicting pneumomediastinum development, as estimated by the Youden index, were 20.2 kg/m2 and 378 U/L, respectively. LDH showed a sensitivity of 61.5% and the highest specificity of 87.8%. Importantly, combining these markers resulted in the highest sensitivity of 100% and a specificity of 71.4%. Conclusion A low BMI and high serum LDH levels at baseline are useful predictive factors for pneumomediastinum development in CTD-ILD patients.

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