Unclassifiable-interstitial lung disease: Outcome prediction using CT and functional indices

Autor: David M. Hansell, Andrew G. Nicholson, Athol U. Wells, Ronald A. Karwoski, Simon L.F. Walsh, Ryoko Egashira, Brian J. Bartholmai, Joseph Jacob, Maria Kokosi, Anne Laure Brun, Srinivasan Rajagopalan, Arjun Nair
Rok vydání: 2017
Předmět:
Male
Multivariate statistics
Cardiac & Cardiovascular Systems
Multivariate analysis
Vital Capacity
Respiratory System
Severity of Illness Index
Idiopathic pulmonary fibrosis
0302 clinical medicine
DLCO
Forced Expiratory Volume
Outcome Assessment
Health Care
Medicine
030212 general & internal medicine
Connective Tissue Diseases
Lung
Carbon Monoxide
Univariate analysis
Interstitial lung disease
Longitudinal analysis
CASE-COHORT
Prognosis
Bronchiectasis
Respiratory Function Tests
PREVALENCE
PROGNOSTIC DETERMINANTS
SURVIVAL
Cardiology
Female
Radiology
Life Sciences & Biomedicine
HYPERSENSITIVITY PNEUMONITIS
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Pulmonary Artery
DIAGNOSIS
1102 Cardiovascular Medicine And Haematology
03 medical and health sciences
FEV1/FVC ratio
Predictive Value of Tests
Internal medicine
Humans
COMPUTED-TOMOGRAPHY
Aged
Science & Technology
HYPERTENSION
business.industry
Proportional hazards model
Quantitative CT
1103 Clinical Sciences
medicine.disease
Idiopathic Pulmonary Fibrosis
030228 respiratory system
Multivariate Analysis
Cardiovascular System & Cardiology
IDIOPATHIC PULMONARY-FIBROSIS
CONNECTIVE-TISSUE DISEASE
Lung Diseases
Interstitial
Tomography
X-Ray Computed
business
Unclassifiable interstitial lung disease
Zdroj: Respiratory Medicine. 130:43-51
ISSN: 0954-6111
DOI: 10.1016/j.rmed.2017.07.007
Popis: Background Unclassifiable-interstitial lung disease (uILD) represents a heterogeneous collection of pathologies encompassing those fibrosing lung diseases which do not fulfill current diagnostic criteria. We evaluated baseline and longitudinal functional and CT (visual and quantitative computer [CALIPER] analysis) variables to identify outcome predictors in uILD. Methods Consecutive patients with uILD on multidisciplinary review (n = 95) had baseline functional (FVC, DLco, CPI [composite physiologic index]) and CT features (visual evaluation: CT pattern, fibrosis extent, honeycombing presence, traction bronchiectasis severity, pulmonary artery (PA) diameter; CALIPER evaluation: fibrosis extent, pulmonary vessel volume (PVV)) examined in univariate and multivariate Cox regression models. Change in functional and CT variables were examined in a patient subset (n = 37), to identify indicators of outcome. Results On univariate analysis, CPI was the most powerful functional predictor of mortality (p < 0.0001). Visual traction bronchiectasis (p < 0.0001), PA diameter (p < 0.0001) and honeycombing presence (p = 0.0001) and CALIPER PVV (p = 0.0003) were the strongest CT outcome predictors. On multivariate analysis of baseline indices, traction bronchiectasis (p = 0.003), PA diameter (p = 0.003) and CPI (p = 0.0001) independently predicted mortality. Colinearity with functional indices precluded the evaluation of CALIPER PVV in multivariate models. On evaluation of longitudinal variables, increasing CALIPER fibrosis extent was the strongest outcome predictor, and remained so following adjustment for baseline disease severity, and when FVC declines were marginal. Conclusions In uILD patients, CPI, traction bronchiectasis severity and PA diameter independently predicted outcome at baseline. Increasing fibrosis extent measured by CALIPER was the most powerful index of outcome regardless of baseline disease severity and strongly predicted outcome in patients with marginal FVC declines.
Databáze: OpenAIRE
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