Abstract
Background: Prognosis of fibrotic idiopathic interstitial pneumonia (IIP) is influenced not only by the histologic pattern observed in lung biopsy but also by high resolution chest tomography (HRCT) and pulmonary function findings.
Aim: To evaluate if functional parameters are better predictors of mortality that HRCT findings in patients with fibrotic IIP.
Methods: We studied 43 patients with fibrotic IIP during a follow-up of 37.2±31.7 months after diagnosis. Baseline HRCT was evaluated for different abnormalities: honeycombing (HC), reticulation, ground-glass, bronchiectasis and total fibrotic score. Pulmonary function was assessed as baseline FVC and change of FVC after 6 months of follow-up (less or more 10%).
Results: Among the different HRCT scores, a cut-off of 10% in the HC score differentiated patients with different survival (5-yrs survival 41% vs 90%, p=0.04). Patients with HC > 10% had a longer duration of symptoms (p=0.04), a lower baseline DLCO (% of predicted, p=0.006) and higher fibrotic and bronchiectasis score (respectively, p=0.04 and p<0.001) than the other patients. A baseline FVC < 76% (median value) and a worsening FVC at 6 months (vs stable-improved) were associated with lower survival (baseline FVC: 5-yrs survival 57% vs 78%, p=0.03; FVC change: 21% vs 75%, p=0.005). In a multivariate logistic analysis taking in consideration clinical, radiological and functional findings, only baseline FVC and FVC change resulted still significant predictors of mortality.
Conclusion: Functional findings are more important prognostic factors of mortality than HRCT parameters in patients with fibrotic IIP.
- © 2011 ERS