title: A simple dyspnoea scale as part of the assessment to predict outcome across chronic interstitial lung disease.
abstract: The Medical Research Council dyspnoea score (MRCDS) is a simple, objective scale to assess dyspnoea, the main complaint in patients with chronic interstitial lung disease (ILD). We sought to investigate whether MRCDS is a predictor of outcome in patients with chronic ILD.
  
  
  
  One hundred and fifteen patients (50 idiopathic pulmonary fibrosis (IPF) and 65 non-IPF ILD) were retrospectively studied. Baseline (time of diagnosis) MRCDS and 3-6-month changes were considered. Endpoints were (i) 18-month clinical progression, defined as either: ≥10% absolute reduction in forced vital capacity (FVC) percent predicted; ≥50-m decline in 6-min walk distance; hospitalization for respiratory causes; lung transplantation (LTx) assessment or death and (ii) 18-month survival.
  
  
  
  At the end of the observation period, 54 subjects (47%) experienced clinical progression (including 22 deaths and 3 LTx). In patients with IPF, a longitudinal increase in MRCDS predicted clinical progression significantly (area under the curve (AUC) = 0.76, sensitivity = 62%, specificity = 91%); baseline MRCDS was a strong predictor of mortality (AUC = 0.80, sensitivity = 87%, specificity = 57%). In patients with non-IPF ILD, longitudinal increases in MRCDS, but not baseline values, were predictive of both clinical progression (AUC = 0.81, sensitivity = 85%, specificity = 77%) and mortality (AUC = 0.76, sensitivity = 91%, specificity = 61%). Considering the whole population, MRCDS increase and FVC decline were independent predictors of mortality.
  
  
  
  Longitudinal increases of MRCDS predict poor outcome in chronic ILD, with good accuracy. Baseline MRCDS remains a strong predictor of mortality in IPF. MRCDS should be included in the global assessment of the clinical course of chronic ILD.
authors.affiliation: Division of Respirology, Western University, London, Ontario, Canada.
authors.forename: Hadeel
authors.initials: H
authors.lastname: Khadawardi
authors.affiliation: Division of Respirology, Western University, London, Ontario, Canada.
authors.forename: Marco
authors.initials: M
authors.lastname: Mura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002908:Chronic Disease; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D017563:Lung Diseases, Interstitial / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016040:Lung Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D005082:Physical Exertion; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014797:Vital Capacity; D000070857:Walk Test
keywords: clinical progression; dyspnoea; interstitial lung disease; outcome; pulmonary fibrosis