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Latent class analysis of chest CT abnormalities to define subphenotypes in patients with MPO-ANCA-positive
Yu Gu1, Ting Zhang1, Min Peng1
1Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, No. 1 Shuai Fu Yuan Street, Dongcheng-Qu, Beijing, 100730, China.
Background:
Patients with microscopic polyangiitis (MPA) and positive myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) may present with various abnormalities in chest computed tomography (CT). This study aimed to identify subphenotypes using latent class analysis (LCA) and to explore the relationship between the subphenotypes and clinical patterns, as well as compare the clinical characteristics of these subphenotypes in patients with MPO-ANCA-positive MPA (MPO-MPA).
Methods:
The study identified subphenotypes using LCA based on chest CT findings in 178 patients with MPO-MPA and pulmonary involvement from June 2014 to August 2022.
Results:
LCA identified 27 participants (15.2%) in class 1, 43 (24.1%) in class 2, 35 (19.7%) in class 3, and 73 (41.0%) in class 4. Class 1 was characterized by prominent inflammatory exudation, class 2 by fibrosis and architectural distortion, class 3 by predominantly bronchiectasis, and class 4 by lesions mixed with inflammation and fibrosis. Class 1 had the highest level of extrapulmonary disease activity, with 77.8% of patients experiencing diffuse alveolar hemorrhage. Class 2 had the lowest level of extrapulmonary disease activity, with 41.9% of patients showing usual interstitial pneumonia. Class 3 patients were more likely to have complications involving the ear, nose, and throat, as well as pulmonary infections before treatment, and they exhibited the best outcomes. The characteristics and outcomes of class 4 were intermediate among the four classes.
Conclusions:
These findings suggest that bronchiectasis may represent a unique pattern of pulmonary involvement in MPO-MPA, highlighting the importance of screening for bronchiectasis in MPO-MPA and identifying optimal management strategies.
Insights
This study identified four distinct chest CT subphenotypes in myeloperoxidase antineutrophil cytoplasmic antibody-positive microscopic polyangiitis (MPO-MPA). Bronchiectasis emerged as a unique pattern, suggesting tailored screening and management for MPO-MPA patients.
Area of Science:
- Pulmonary Medicine
- Radiology
- Immunology
Background:
- Microscopic polyangiitis (MPA) with positive myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) presents with diverse chest CT abnormalities.
- Identifying distinct imaging subphenotypes is crucial for understanding disease heterogeneity in MPO-ANCA-positive MPA (MPO-MPA).
Purpose of the Study:
- To identify chest CT subphenotypes in MPO-MPA using latent class analysis (LCA).
- To explore the relationship between these subphenotypes and clinical patterns.
- To compare clinical characteristics and outcomes across identified MPO-MPA subphenotypes.
Main Methods:
- Latent class analysis (LCA) was employed to categorize chest CT findings.
- The study included 178 patients with MPO-MPA and pulmonary involvement.
- Data were collected between June 2014 and August 2022.
Main Results:
- Four distinct subphenotypes were identified: inflammatory exudation (Class 1), fibrosis/architectural distortion (Class 2), bronchiectasis (Class 3), and mixed inflammation/fibrosis (Class 4).
- Class 1 showed high extrapulmonary activity and diffuse alveolar hemorrhage; Class 2 exhibited usual interstitial pneumonia and low extrapulmonary activity.
- Class 3, characterized by bronchiectasis, had ENT complications, pre-treatment infections, and the best outcomes; Class 4 had intermediate characteristics.
Conclusions:
- Bronchiectasis represents a unique pulmonary involvement pattern in MPO-MPA.
- Screening for bronchiectasis in MPO-MPA is important.
- Optimal management strategies should be identified for these distinct MPO-MPA subphenotypes.
