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Acute exacerbation was defined as significant respiratory deterioration including clinical worsening of dyspnoea, hypoxemia, or the worsening or severe impairment of gas exchange characterized by new bilateral GGO /consolidation superimposed on a background pattern consistent with an ILD pattern not fully explained by cardiac failure or fluid overload 47,48

The 10-mL serum tube was placed in a 37 C incubator for 60 min, allowing the blood to clot, and then stored overnight at 4 C

Independent samples t -tests Results from independent samples t -tests on the nine unadjusted metabolite concentrations (glutathione, glutamate, and glutamine in each of the three voxels) are given in Table 1

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