title: Radiographic fibrosis score predicts survival in hypersensitivity pneumonitis.
abstract: BACKGROUND
  It is unknown if the radiographic fibrosis score predicts mortality in persistent hypersensitivity pneumonitis (HP) and if survival is similar to that observed in idiopathic pulmonary fibrosis (IPF) when adjusting for the extent of radiographic fibrosis.
  
  
  METHODS
  We reviewed records from 177 patients with HP and 224 patients with IPF whose diagnoses were established by multidisciplinary consensus. Two thoracic radiologists scored high-resolution CT (HRCT) scan lung images. Independent predictors of transplant-free survival were determined using a Cox proportional hazards analysis. Kaplan-Meier survival curves were constructed, stratified by disease as well as fibrosis score.
  
  
  RESULTS
  HRCT scan fibrosis score and radiographic reticulation independently predicted time to death or lung transplantation. Clinical predictors included a history of cigarette smoking, auscultatory crackles on lung examination, baseline FVC, and FEV1/FVC ratio. The majority of HP deaths occurred in patients with both radiographic reticulation and auscultatory crackles on examination, compared with patients with only one of these manifestations (P &lt; .0001). Patients with IPF had worse survival than those with HP at any given degree of radiographic fibrosis (hazard ratio 2.31; P &lt; .01).
  
  
  CONCLUSIONS
  Survival in patients with HP was superior to that of those with IPF with similar degrees of radiographic fibrosis. The combination of auscultatory crackles and radiographic reticulation identified patients with HP who had a particularly poor outcome.
authors: Department of Medicine, University of California, San Francisco, CA.
authors: Joshua J
authors: JJ
authors: Mooney
authors: Department of Radiology, University of California, San Francisco, CA.
authors: Brett M
authors: BM
authors: Elicker
authors: Department of Radiology, University of California, San Francisco, CA.
authors: Thomas H
authors: TH
authors: Urbania
authors: Department of Medicine, University of California, San Francisco, CA.
authors: Misha R
authors: MR
authors: Agarwal
authors: Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors: Christopher J
authors: CJ
authors: Ryerson
authors: Department of Medicine, University of California, San Francisco, CA.
authors: Michelle Linh T
authors: MLT
authors: Nguyen
authors: Department of Medicine, University of California, San Francisco, CA.
authors: Prescott G
authors: PG
authors: Woodruff
authors: Department of Pathology, University of California, San Francisco, CA.
authors: Kirk D
authors: KD
authors: Jones
authors: Department of Medicine, University of California, San Francisco, CA.
authors: Harold R
authors: HR
authors: Collard
authors: Department of Medicine, University of California, San Francisco, CA.
authors: Talmadge E
authors: TE
authors: King
authors: Department of Medicine, University of California, San Francisco, CA. Electronic address: Laura.Koth@ucsf.edu.
authors: Laura L
authors: LL
authors: Koth
mesh_terms: D000368:Aged; D000542:Alveolitis, Extrinsic Allergic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D001706:Biopsy; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012042:Registries; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014057:Tomography, X-Ray Computed