Correlation of serum Krebs von den Lungen-6 levels with fibrosis score on high resolution chest tomography and pulmonary function parameters in treatment naïve Idiopathic Pulmonary Fibrosis
Main Article Content
Keywords
Correlation, Krebs von den lungen-6, Fibrosis score, High resolution chest tomography, Treatment naïve, Idiopathic pulmonary fibrosis
Abstract
Background: While serum Krebs von den Lungen-6 (KL-6) has been found to be a helpful biomarker in interstitial lung diseases for evaluating disease severity and progression, especially in connective tissue disease-associated interstitial lung disease (CTD ILD) and idiopathic non-specific interstitial pneumonia (NSIP), data on correlation of serum KL-6 levels with radiological fibrosis and pulmonary function parameters is lacking in treatment naïve Idiopathic Pulmonary Fibrosis (IPF) patients. Methods: Serum KL-6 levels were measured in thirty-nine treatment naïve newly detected IPF patients using automated immunofluorescence enzyme assay (AIA) by Tosoh Corporation, bioscience division, Tokyo, Japan. Fibrosis score was calculated by independent visual assessment of the pattern and severity of abnormalities on high resolution computed tomography (HRCT) thorax. HRCT fibrosis scores were correlated with serum KL-6 levels and pulmonary function parameters like forced vital capacity (FVC), diffusion capacity of lung for carbon monoxide (DLco). Results: Median value of serum KL-6 levels was 1519 U/ml (range 199.41-6055 U/ml). There was positive correlation of serum KL-6 with HRCT fibrosis score (r=0.692, p<0.001) and negative correlation with FVC (r=-0.511, p=0.001) and DLco (r=-0.354, p=0.043). In the HRCT fibrosis score pattern subset analysis, the presence of reticulation revealed weak negative and statistically insignificant correlation (r=-0.116, p=0.481) while traction bronchiectasis and honeycombing exhibited statistically significant positive correlation (r=0.425, p=0.007; r=0.584, p<0.001 respectively) with serum KL-6 levels. Conclusion: Serum KL-6 levels showed a positive correlation with the degree of fibrotic abnormalities on HRCT thorax and pulmonary function parameters, indicating a potential use of serum KL-6 in monitoring of parenchymal fibrosis in Idiopathic Pulmonary fibrosis.
References
2. Ishikawa N, Hattori N, Yokoyama A, Kohno N. Utility of KL-6/MUC1 in the clinical management of interstitial lung diseases. Respir Investig 2012;50(1):3-13. doi:10.1016/j.resinv.2011.11.002.
3. Crestani B. Molecular biomarkers in idiopathic pulmonary fibrosis and disease severity. Sarcoidosis Vasc Diffuse Lung Dis. 2013 Sep; doi:10.36141/svdld.v30i3.200.
4. Barlo NP, van Moorsel CH, van den Bosch JM, Grutters JC. Predicting prognosis in idiopathic pulmonary fibrosis. Sarcoidosis Vasc Diffuse Lung Dis. 2010 Jul 1;27(2):85-95. doi:10.36141/svdld.v27i2.107.
5. Raghu G, Remy-Jardin M, Myers JL, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med 2018;198(5):e44-68. doi:10.1164/rccm.201807-1255ST.
6. Qin H, Xu XP, Zou J, et al. Krebs von den Lungen-6 associated with chest high-resolution CT score in evaluation severity of patients with interstitial lung disease. Pulmonology 2019;25(3):143-148. doi:10.1016/j.pulmoe.2018.09.004.
7. Üçsular F, Karadeniz G, Polat G, et al. Quantitative CT in mortality prediction in pulmonary fibrosis with or without emphysema. Sarcoidosis Vasc Diffuse Lung Dis. 2021;38(3):e2021024. doi: 10.36141/svdld.v38i3.11044.
8. Oda K, Ishimoto H, Yatera K, et al. High-resolution CT scoring system-based grading scale predicts the clinical outcomes in patients with idiopathic pulmonary fibrosis. Respir Res 2014;15(1):1-9. doi:10.1186/s12931-014-0155-4.
9. Majewski S, Szewczyk K, Żal A, et al. Serial measurements of circulating KL-6, SP-D, MMP-7, CA19-9, CA-125, CCL18, and periostin in patients with idiopathic pulmonary fibrosis receiving antifibrotic therapy: an exploratory study. J Clin Med 2021;10(17):3864. doi:10.3390/jcm10173864.
10. Wakamatsu K, Nagata N, Kumazoe H, et al. Prognostic value of serial serum KL-6 measurements in patients with idiopathic pulmonary fibrosis. Respir Investig 2017;55(1):16-23. doi:10.1016/j.resinv.2016.07.004.
11. Millan Billi P, Castellví I, Martinez Martinez L, et al. Diagnostic value of serum KL-6 in interstitial lung disease: Preliminary results from an European cohort. ILD/DPLD of known origin. 2018; doi:10.1183/13993003.congress-2018.pa2959.
12. Bonella F, Volpe A, Caramaschi P, et al. Surfactant protein D and KL-6 serum levels in systemic sclerosis: correlation with lung and systemic involvement. Sarcoidosis Vasc Diffuse Lung Dis; 28(1):27-33. doi:10.1036/1073-449x.28.1.27.
13. Choi MG, Choi SM, Lee JH, et al. Blood Krebs von den Lungen-6 levels predict treatment response to antifibrotic therapy in patients with idiopathic pulmonary fibrosis. Respir Res 2022; 23(1):1-9. doi:10.1186/s12931-022-02057-4.
14. Hisata S, Kimura Y, Shibata N, et al. A Normal Range of KL-6/MUC1 Independent of Elevated SP-D Indicates a Better Prognosis in the Patients with Honeycombing on High-Resolution Computed Tomography. Pulm Med 2011;2011:1-7. doi:10.1155/2011/806014.
15. Zheng M, Lou A, Zhang H, et al. Serum KL-6, CA19-9, CA125 and CEA are diagnostic biomarkers for rheumatoid arthritis-associated interstitial lung disease in the Chinese population. Rheumatol Ther 2021; 8:517-527. doi:10.1007/s40744-020-00286-w.
16. Isaac BT, Thangakunam B, Cherian RA, et al. The correlation of symptoms, pulmonary function tests and exercise testing with high-resolution computed tomography in patients with idiopathic interstitial pneumonia in a tertiary care hospital in South India. Lung India 2015; 32(6):584. doi:10.4103/0970-2113.168131.
17. Palermo M, Tiralongo F, Distefano G, et al. Quantitative evaluation of fibrosis in IPF patients: Meaning of diffuse pulmonary ossification. Diagnostics 2021; 11(1):113. doi:10.3390/diagnostics11010113.
18. Zhu C, Zhao YB, Kong LF, et al. The expression and clinical role of KL-6 in serum and BALF of patients with different diffuse interstitial lung diseases. Chin J Tuberc Respir Dis 2016;39(2):93-97. doi:10.3760/cma.j.issn.1001-0939.2016.
Article Sidebar
Article Details
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Anissa Atif Mirza, Department of Biochemistry, All India Institute of Medical Sciences Rishikesh, Dehradun, 249203, Uttarakhand, India
Professor
Yogesh Arvind Bahurupi, Department of Community and Family Medicine, All India Institute of Medical Sciences Rishikesh, Dehradun, 249203, Uttarakhand, India
Associate Professor
How to Cite
