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Respir Med. 2017 Oct;131:229-235. doi: 10.1016/j.rmed.2017.08.025. Epub 2017 Sep 12.

Possible UIP pattern on high-resolution computed tomography is associated with better survival than definite UIP in IPF patients.

Author information

1
University of Michigan Health System, Ann Arbor, MI, United States. Electronic address: msalisbu@med.umich.edu.
2
Cleveland Clinic Foundation, Cleveland, OH, United States.
3
University of Michigan, Department of Biostatistics, Ann Arbor, MI, United States.
4
University of Texas, MD Anderson Cancer Center, Department of Biostatistics, Houston, TX, United States.
5
University of Texas Health Science Center at San Antonio and the South Texas Veterans Health Care System, San Antonio, TX, United States.
6
Spectrum Health, Grand Rapids, MI, United States.
7
University of Michigan Health System, Ann Arbor, MI, United States.
8
Jefferson University, Philadelphia, PA, United States.
9
Cornell Medical College, New York, NY, United States.

Abstract

BACKGROUND:

Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease of unknown etiology. Inter-society consensus guidelines on IPF diagnosis and management outline radiologic patterns including definite usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. We evaluate these diagnostic categories as prognostic markers among patients with IPF.

METHODS:

Included subjects had biopsy-proven UIP, a multidisciplinary team diagnosis of IPF, and a baseline high-resolution computed tomography (HRCT). Thoracic radiologists assigned the radiologic pattern and documented the presence and extent of specific radiologic findings. The outcome of interest was lung transplant-free survival.

RESULTS:

IPF patients with a possible UIP pattern on HRCT had significantly longer Kaplan-Meier event-free survival compared to those with definite UIP pattern (5.21 and 3.57 years, respectively, p = 0.002). In a multivariable Cox proportional hazards model adjusted for baseline age, gender, %-predicted FVC, and %-predicted DLCO via the GAP Stage, extent of fibrosis (via the traction bronchiectasis score) and ever-smoker status, possible UIP pattern on HRCT (versus definite UIP) was associated with reduced hazard of death or lung transplant (HR = 0.42, CI 95% 0.23-0.78, p = 0.006).

CONCLUSIONS:

Radiologic diagnosis categories outlined by inter-society consensus guidelines is a widely-reported and potentially useful prognostic marker in IPF patients, with possible UIP pattern on HRCT associated with a favorable prognosis compared to definite UIP pattern, after adjusting for relevant covariates.

KEYWORDS:

High resolution computed tomography; Prognosis; Pulmonary fibrosis; Usual interstitial pneumonia

PMID:
28947036
PMCID:
PMC5679475
DOI:
10.1016/j.rmed.2017.08.025
[Indexed for MEDLINE]
Free PMC Article

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