{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T15:43:42Z","timestamp":1793720622457,"version":"4.6.1"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T00:00:00Z","timestamp":1752710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis with interstitial lung disease (MDA5\n                      <jats:sup>+<\/jats:sup>\n                      DM-ILD) carries a high mortality risk. This meta-analysis aimed to identify mortality risk factors to guide early clinical intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2019s Q, one-by-one elimination, and Egger\u2019s tests, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 (\u2265800 ng\/mL) (HR = 6.17, 95%CI: 2.51, 15.20), and lymphocyte count (&amp;lt;1.1\u00d710\n                      <jats:sub>9<\/jats:sub>\n                      \/L) (HR = 4.88, 95%CI: 1.80, 13.20). Higher PaO\n                      <jats:sub>2<\/jats:sub>\n                      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%), and erythrocyte sedimentation rate (ESR) showed no significant associations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Age, smoking, fever, inflammatory markers, and RP-ILD are critical mortality risk factors in MDA5\n                      <jats:sup>+<\/jats:sup>\n                      DM-ILD. Early identification and management of these factors may improve prognosis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>http:\/\/INPLASY.com<\/jats:uri>\n                      , identifier INPLASY202540058.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1628748","type":"journal-article","created":{"date-parts":[[2025,7,17]],"date-time":"2025-07-17T05:24:15Z","timestamp":1752729855000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Risk factors for mortality in anti-MDA5 antibody-positive dermatomyositis with interstitial lung disease: a systematic review and 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