| Autor: |
Rose JA; Division of Pulmonary and Critical Care Medicine., Tukpah AC; Division of Pulmonary and Critical Care Medicine., Cutting C; Division of Pulmonary and Critical Care Medicine., Wada N; Department of Radiology, and., Nishino M; Department of Radiology, and.; Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts., Moll M; Division of Pulmonary and Critical Care Medicine.; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.; Section on Pulmonary, Critical Care, Sleep, and Allergy, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts., Kalra S; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Choi B; Division of Pulmonary and Critical Care Medicine., Lynch DA; Department of Radiology, National Jewish Health, Denver, Colorado., Raby BA; Division of Pulmonary and Critical Care Medicine.; Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; and., Rosas IO; Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas., San José Estépar R; Department of Radiology, and., Washko GR; Division of Pulmonary and Critical Care Medicine., Silverman EK; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Cho MH; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts., Hatabu H; Department of Radiology, and., Putman RK; Division of Pulmonary and Critical Care Medicine., Hunninghake GM; Division of Pulmonary and Critical Care Medicine. |
| Abstrakt: |
Rationale: Some with interstitial lung abnormalities (ILA) are suspected to have interstitial lung disease (ILD), a subgroup with adverse outcomes. Rates of development and progression of suspected ILD and their effect on mortality are unknown. Objectives: To determine rates of development, progression, and mortality in those with suspected ILD and assess effects of individual ILD and progression criteria. Methods: Participants from COPDGene (Genetic Epidemiology of Chronic Obstructive Pulmonary Disease) with ILA characterization and FVC at enrollment and 5-year follow-up were included. ILD was defined as ILA and fibrosis and/or FVC < 80% predicted. Prevalent ILD was assessed at enrollment and incident ILD and progression were assessed at 5-year follow-up. Computed tomography (CT) progression was assessed visually and FVC decline as relative change. Multivariable Cox regression tested associations between mortality and prevalent ILD, incident ILD, and progression groups. Measurements and Main Results: Of 9,588 participants at enrollment, 268 (2.8%; 51% of ILA) had prevalent ILD. Those with prevalent ILD had 51% mortality after median 10.6 years, which was higher than those with ILA without prevalent ILD (henceforth ILA) (33%; hazard ratio [HR], 2.0; P < 0.001). The subgroup of prevalent ILD with only fibrosis criteria (FVC ≥ 80%) had worse mortality (58%) than ILA (HR, 2.2; P < 0.001). A total of 98 participants with prevalent ILD completed 5-year follow-up: 33% had stable CT and relative FVC decline <10%, 6% had FVC decline ≥10% only, 39% had CT progression only, and 22% had both CT progression and FVC decline ≥10%. Mortality rates were 31%, 50%, 45%, and 45%, respectively; those with only CT progression had worse mortality than those with ILA (HR, 2.6; P = 0.005). At 5-year follow-up, incident ILD occurred in 148/4,842 participants without prevalent ILD (5.5/1,000 person-years) and had worse mortality than ILA (HR, 2.4; P < 0.001). Conclusion: Rates of mortality and progression are high among those with suspected ILD in COPDGene; fibrosis and radiologic progression are important predictors of mortality. |
