Risk factors for mortality in anti-MDA5 antibody-positive dermatomyositis with interstitial lung disease: a systematic review and meta-analysis

作者：Yahui Yang, Ying Li, Weiwei Yuan, Shijie Zhang, Xing He, Jiaqi Ji · 发表于：Frontiers in Immunology · 年份：2025 · DOI：10.3389/fimmu.2025.1628748 · 被引用次数：9 · 研究领域：Inflammatory Myopathies and Dermatomyositis、Parkinson's Disease and Spinal Disorders、Skin Diseases and Diabetes

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 (<1.1×10 9 /L) (HR = 4.88, 95%CI: 1.80, 13.20). Higher PaO 2 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%), a...