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Abstract Number: 2892

Serum Level of KL-6, a Biomarker of Interstitial Lung Disease (ILD), Is Higher in Diffuse SSc Than in Limited SSc and RA Even When the Activity of ILD Is Low

Tamao Nakashita1, Shinji Motojima2, Akira Jibatake2, Akira Yoshida2 and Yoshiki Yamamoto2, 1Department of Rheumatology and Allergy, Kameda Medical Center, Kamogawa-city, Japan, 2Department of Rheumatology and Allergy, Kameda Medical Center, Kamogawa city, Japan

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Biomarkers, interstitial lung disease, rheumatoid arthritis (RA) and systemic sclerosis

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Session Information

Date: Tuesday, November 15, 2016

Session Title: Systemic Sclerosis, Fibrosing Syndromes, and Raynaud's – Clinical Aspects and Therapeutics - Poster III

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:  KL-6 is a glycoprotein expressed on and released from type 2 alveolar cells and the measurement of KL-6 in serum was developed by Kohno et al (Am J Respir Crit Care Med 1993). Serum levels of KL-6 have been reported to be higher in ILD (Ohnishi H, Am J Respir Crit Care Med 2002) and be a predictor of prognosis of ILD (Yokiyama A, Am J Respir Crit Care Med 1998). We also reported that serum levels of KL-6 increased when ILD exacerbated after administration of TNF-inhibitors in RA (Nakashita T, BMJ open 2014). Normal range of serum KL-6 is less than 500 U/ml and serum level of more than 1,000 U/ml is a predictor of poor prognosis. However, we have noticed that in some patients serum KL-6 levels are sustained in high levels even when the activity of ILD deceased. We tried to detect the factors that contribute in sustaining serum KL-6 levels high.

Methods:  Subjects were 98 patients including 52 RA, 19 diffuse SSc, and 27 limited SSc. These patients fulfilled the following requirements; 1. presence of ILD proved by chest CT, 2. no changes in chest CT findings for more than 2 years, 3. less than 5 % changes in % VC for more than 2 years, suggesting that the ILD is stable during the period. Serum KL-6 levels were checked periodically, every 2 – 6 months, from the first visit to our department. Nine variables were checked including diagnosis (RA, d-SSc, l-SSC), age, gender, ILD pattern (UIP, NSIP, organizing pneumonia), ILD grade (1 – 3 according to Nakashita), % VC, peak serum KL-6 value, peripheral blood eosinophil count, ANA titer, and RF titer. These variables were statistically analyzed.

Results: Serum KL-6 value was highest in d-SSc followed by l-SSc and RA; the mean values were 776 U/ml, 439 U/ml, and 371 U/ml, respectively (p < 0.0001). % VC values were lowest in d-SSc followed by l-SSc and RA; the mean values were 90.1 %, 98.9 %, and 107.2 %, respectively (p < 0.02). Multivariate analysis was done using 10 variables to extract factors that contribute to discriminate 2 groups, i.e. a very high KL-6 group (KL-6 >= 900 U/ml) and another group (KL6 < 900 U/ml). In a very high KL-6 group included 10 patients. Factors that contribute to discriminate 2 groups (p < 0.1) were diagnosis (RA, d-SSc or l-SSc), % VC, and peak serum KL-6 values. Multiple regression analysis was also done. Multiple regression coefficient was moderately high (0.78), but significant regression factors were diagnosis and peak KL-6 value.

Conclusion: Patients with d-SSc, low % VC and high peak KL-6 value tend to show high serum KL-6 values even when ILD is not active. Our results can contribute to avoid aggressive treatment for patients with stable but very high serum KL-6 levels.


Disclosure: T. Nakashita, None; S. Motojima, None; A. Jibatake, None; A. Yoshida, None; Y. Yamamoto, None.

To cite this abstract in AMA style:

Nakashita T, Motojima S, Jibatake A, Yoshida A, Yamamoto Y. Serum Level of KL-6, a Biomarker of Interstitial Lung Disease (ILD), Is Higher in Diffuse SSc Than in Limited SSc and RA Even When the Activity of ILD Is Low [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/serum-level-of-kl-6-a-biomarker-of-interstitial-lung-disease-ild-is-higher-in-diffuse-ssc-than-in-limited-ssc-and-ra-even-when-the-activity-of-ild-is-low/. Accessed June 28, 2022.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/serum-level-of-kl-6-a-biomarker-of-interstitial-lung-disease-ild-is-higher-in-diffuse-ssc-than-in-limited-ssc-and-ra-even-when-the-activity-of-ild-is-low/

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