Prognostic determinants among clinical, thin-section CT, and histopathologic findings for fibrotic idiopathic interstitial pneumonias: tertiary hospital study.
OBJECTIVE
To evaluate the utility of clinical, thin-section computed tomography (CT), and histopathologic findings in predicting the prognosis of patients with usual interstitial pneumonia (UIP) or fibrotic nonspecific interstitial pneumonia (NSIP).


METHODS
The institutional review board approved this retrospective study, with waiver of informed consent. Included were 108 patients (71 men, 37 women; mean age, 61 years +/- 8 [standard deviation]) with UIP (n = 79; 60 men, 19 women; mean age, 63 years +/- 7.4) and fibrotic NSIP (n = 29; 11 men, 18 women; mean age, 57 years +/- 12.9). Patients underwent pulmonary function tests (PFTs), bronchoalveolar lavage (BAL) fluid analysis, and thin-section CT. Two chest radiologists independently assigned scores for the extent of lung abnormalities detected at CT twice at 3-month intervals. The effect of histopathologic diagnoses and clinical and thin-section CT features on survival was evaluated by using Cox regression analyses.


RESULTS
The 5-year survival rate (mean follow-up, 45 months) of patients with fibrotic NSIP was 76% in contrast to 46% for patients with UIP (P = .006). With multivariate analysis, a high fibrotic score (the extent of reticulation plus honeycombing) (hazard ratio = 1.200, P = .043) and an initial low diffusing capacity of lung for carbon monoxide (Dlco) level (hazard ratio = 0.973, P = .025) were identified as associated with increased death risk.


CONCLUSIONS
Patients with UIP or fibrotic NSIP who have a high fibrotic score determined at thin-section CT and a low Dlco level appear to have a high death risk.
Shin
Kyung Min
KM
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
Lee
Kyung Soo
KS
Chung
Man Pyo
MP
Han
Joungho
J
Bae
Young A
YA
Kim
Tae Sung
TS
Chung
Myung Jin
MJ
D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D002248:Carbon Monoxide; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011653:Pulmonary Diffusing Capacity; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed
D002248:Carbon Monoxide