This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200211-1311OCv1 168/5/538    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Collard, H. R. Articles by Brown, K. K. Search for Related Content PubMed PubMed Citation Articles by Collard, H. R. Articles by Brown, K. K.

Changes in Clinical and Physiologic Variables Predict Survival in Idiopathic Pulmonary Fibrosis

Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Health Sciences; National Jewish Medical and Research Center, Denver; Department of Biostatistics and Clinical Studies, NetRegulus, Centennial, Colorado; and Department of Medicine, San Francisco General Hospital, University of California at San Francisco, San Francisco, California

Correspondence and requests for reprints should be addressed to Kevin K. Brown, M.D., 1400 Jackson Street, Room F107, Denver, CO 80206. E-mail: brownk{at}njc.org

There is significant heterogeneity in survival time among patients with idiopathic pulmonary fibrosis. Studies of baseline clinical and physiologic variables as predictors of survival time have reported inconsistent results. We evaluated the predictive value of changes in clinical and physiologic variables over time for survival time in 81 patients with biopsy-proven idiopathic pulmonary fibrosis. Six-month changes in dyspnea score, total lung capacity, thoracic gas volume, FVC, FEV₁, diffusing capacity of carbon monoxide, partial pressure of arterial oxygen, oxygen saturation, and alveolar–arterial oxygen gradient were predictive of survival time even after adjustment for baseline values. Analyses were repeated on 51 patients with 12-month change data. Twelve-month changes in dyspnea score, total lung capacity, FVC, partial pressure of arterial oxygen, oxygen saturation, and alveolar–arterial oxygen gradient were predictive of survival time after adjustment for baseline values. Evaluation of changes in clinical and physiological variables over 6 and 12 months may provide clinicians with more accurate prognostic information than baseline values alone.

Key Words: interstitial lung disease • pulmonary fibrosis • survival

This article has been cited by other articles:

				M. K. Han, S. Murray, C. D. Fell, K. R. Flaherty, G. B. Toews, J. Myers, T. V. Colby, W. D. Travis, E. A. Kazerooni, B. H. Gross, et al. Sex differences in physiological progression of idiopathic pulmonary fibrosis Eur. Respir. J., June 1, 2008; 31(6): 1183 - 1188. [Abstract] [Full Text] [PDF]

				A E Holland, C J Hill, M Conron, P Munro, and C F McDonald Short term improvement in exercise capacity and symptoms following exercise training in interstitial lung disease Thorax, June 1, 2008; 63(6): 549 - 554. [Abstract] [Full Text] [PDF]

				W A Wuyts, M Thomeer, L J Dupont, and G M Verleden An algorithm for referral of patients with IPF for lung transplantation Thorax, March 1, 2008; 63(3): 292 - 292. [Full Text] [PDF]

				B. W. Kinder, K. K. Brown, M. I. Schwarz, J. H. Ix, A. Kervitsky, and T. E. King Jr Baseline BAL Neutrophilia Predicts Early Mortality in Idiopathic Pulmonary Fibrosis Chest, January 1, 2008; 133(1): 226 - 232. [Abstract] [Full Text] [PDF]

				L. S Mackay, R. L Anderson, G. Parry, J. Lordan, P. A Corris, and A. J Fisher Pulmonary fibrosis: rate of disease progression as a trigger for referral for lung transplantation Thorax, December 1, 2007; 62(12): 1069 - 1073. [Abstract] [Full Text] [PDF]

				J. H. T. Bates, G. S. Davis, A. Majumdar, K. J. Butnor, and B. Suki Linking Parenchymal Disease Progression to Changes in Lung Mechanical Function by Percolation Am. J. Respir. Crit. Care Med., September 15, 2007; 176(6): 617 - 623. [Abstract] [Full Text] [PDF]

				K. K. Brown Roger S. Mitchell Lecture. Rheumatoid Lung Disease Proceedings of the ATS, August 15, 2007; 4(5): 443 - 448. [Abstract] [Full Text] [PDF]

				I. Noth and F. J. Martinez Recent Advances in Idiopathic Pulmonary Fibrosis Chest, August 1, 2007; 132(2): 637 - 650. [Abstract] [Full Text] [PDF]

				S. D. Nathan, P. W. Noble, and R. M. Tuder Idiopathic Pulmonary Fibrosis and Pulmonary Hypertension: Connecting the Dots Am. J. Respir. Crit. Care Med., May 1, 2007; 175(9): 875 - 880. [Abstract] [Full Text] [PDF]

				M. Alakhras, P. A. Decker, H. F. Nadrous, M. Collazo-Clavell, and J. H. Ryu Body Mass Index and Mortality in Patients With Idiopathic Pulmonary Fibrosis Chest, May 1, 2007; 131(5): 1448 - 1453. [Abstract] [Full Text] [PDF]

				A. U. Wells and C. M. Hogaboam Update in Diffuse Parenchymal Lung Disease 2006 Am. J. Respir. Crit. Care Med., April 1, 2007; 175(7): 655 - 660. [Full Text] [PDF]

				K. Hamada, S. Nagai, S. Tanaka, T. Handa, M. Shigematsu, T. Nagao, M. Mishima, M. Kitaichi, and T. Izumi Significance of Pulmonary Arterial Pressure and Diffusion Capacity of the Lung as Prognosticator in Patients With Idiopathic Pulmonary Fibrosis Chest, March 1, 2007; 131(3): 650 - 656. [Abstract] [Full Text] [PDF]

				O.J. Dempsey, K.M. Kerr, L. Gomersall, H. Remmen, and G.P. Currie Idiopathic pulmonary fibrosis: an update QJM, October 1, 2006; 99(10): 643 - 654. [Abstract] [Full Text] [PDF]

				K. R. Flaherty, A.-C. Andrei, S. Murray, C. Fraley, T. V. Colby, W. D. Travis, V. Lama, E. A. Kazerooni, B. H. Gross, G. B. Toews, et al. Idiopathic Pulmonary Fibrosis: Prognostic Value of Changes in Physiology and Six-Minute-Walk Test Am. J. Respir. Crit. Care Med., October 1, 2006; 174(7): 803 - 809. [Abstract] [Full Text] [PDF]

				D. J. Lederer, S. M. Arcasoy, J. S. Wilt, F. D'Ovidio, J. R. Sonett, and S. M. Kawut Six-Minute-Walk Distance Predicts Waiting List Survival in Idiopathic Pulmonary Fibrosis Am. J. Respir. Crit. Care Med., September 15, 2006; 174(6): 659 - 664. [Abstract] [Full Text] [PDF]

				K. M. Antoniou, A. G. Nicholson, M. Dimadi, K. Malagari, P. Latsi, A. Rapti, N. Tzanakis, R. Trigidou, V. Polychronopoulos, and D. Bouros Long-term clinical effects of interferon gamma-1b and colchicine in idiopathic pulmonary fibrosis Eur. Respir. J., September 1, 2006; 28(3): 496 - 504. [Abstract] [Full Text] [PDF]

				F. J. Martinez and M. P. Keane Update in diffuse parenchymal lung diseases 2005. Am. J. Respir. Crit. Care Med., May 15, 2006; 173(10): 1066 - 1071. [Full Text] [PDF]

				G. Raghu, S. T.-Y. Yang, C. Spada, J. Hayes, and C. A. Pellegrini Sole Treatment of Acid Gastroesophageal Reflux in Idiopathic Pulmonary Fibrosis: A Case Series Chest, March 1, 2006; 129(3): 794 - 800. [Abstract] [Full Text] [PDF]

				P. Pignatti, G. Brunetti, D. Moretto, M.-R. Yacoub, M. Fiori, B. Balbi, A. Balestrino, G. Cervio, S. Nava, and G. Moscato Role of the Chemokine Receptors CXCR3 and CCR4 in Human Pulmonary Fibrosis Am. J. Respir. Crit. Care Med., February 1, 2006; 173(3): 310 - 317. [Abstract] [Full Text] [PDF]

				F. J. Martinez Idiopathic Interstitial Pneumonias: Usual Interstitial Pneumonia versus Nonspecific Interstitial Pneumonia. Proceedings of the ATS, January 1, 2006; 3(1): 81 - 95. [Abstract] [Full Text] [PDF]

				D. S. Kim, H. R. Collard, and T. E. King Jr. Classification and natural history of the idiopathic interstitial pneumonias. Proceedings of the ATS, January 1, 2006; 3(4): 285 - 292. [Abstract] [Full Text] [PDF]

				F. J. Martinez and K. Flaherty Pulmonary function testing in idiopathic interstitial pneumonias. Proceedings of the ATS, January 1, 2006; 3(4): 315 - 321. [Abstract] [Full Text] [PDF]

				M. Demedts, J. Behr, R. Buhl, U. Costabel, R. Dekhuijzen, H. M. Jansen, W. MacNee, M. Thomeer, B. Wallaert, F. Laurent, et al. High-Dose Acetylcysteine in Idiopathic Pulmonary Fibrosis. N. Engl. J. Med., November 24, 2005; 353(21): 2229 - 2242. [Abstract] [Full Text] [PDF]

				W. C. Johnson and G. Raghu Clinical trials in idiopathic pulmonary fibrosis: a word of caution concerning choice of outcome measures Eur. Respir. J., November 1, 2005; 26(5): 755 - 758. [Full Text] [PDF]

				R. Pellegrino, G. Viegi, V. Brusasco, R. O. Crapo, F. Burgos, R. Casaburi, A. Coates, C. P. M. van der Grinten, P. Gustafsson, J. Hankinson, et al. Interpretative strategies for lung function tests Eur. Respir. J., November 1, 2005; 26(5): 948 - 968. [Full Text] [PDF]

				S. D. Nathan Therapeutic Intervention: Assessing the Role of the International Consensus Guidelines Chest, November 1, 2005; 128(5_suppl_1): 533S - 539S. [Abstract] [Full Text] [PDF]

				H. F. Nadrous, P. A. Pellikka, M. J. Krowka, K. L. Swanson, N. Chaowalit, P. A. Decker, and J. H. Ryu Pulmonary Hypertension in Patients With Idiopathic Pulmonary Fibrosis Chest, October 1, 2005; 128(4): 2393 - 2399. [Abstract] [Full Text] [PDF]

				M. A Pacanowski and G. W Amsden Interferon Gamma-1b in the Treatment of Idiopathic Pulmonary Fibrosis Ann. Pharmacother., October 1, 2005; 39(10): 1678 - 1686. [Abstract] [Full Text] [PDF]

				T. Eaton, P. Young, D. Milne, and A. U. Wells Six-Minute Walk, Maximal Exercise Tests: Reproducibility in Fibrotic Interstitial Pneumonia Am. J. Respir. Crit. Care Med., May 15, 2005; 171(10): 1150 - 1157. [Abstract] [Full Text] [PDF]

				R. M. du Bois Is Idiopathic Pulmonary Fibrosis Now Treatable? Am. J. Respir. Crit. Care Med., May 1, 2005; 171(9): 939 - 940. [Full Text] [PDF]

				A. Azuma, T. Nukiwa, E. Tsuboi, M. Suga, S. Abe, K. Nakata, Y. Taguchi, S. Nagai, H. Itoh, M. Ohi, et al. Double-blind, Placebo-controlled Trial of Pirfenidone in Patients with Idiopathic Pulmonary Fibrosis Am. J. Respir. Crit. Care Med., May 1, 2005; 171(9): 1040 - 1047. [Abstract] [Full Text] [PDF]

				I. Ito, S. Nagai, M. Kitaichi, A. G. Nicholson, T. Johkoh, S. Noma, D. S. Kim, T. Handa, T. Izumi, and M. Mishima Pulmonary Manifestations of Primary Sjogren's Syndrome: A Clinical, Radiologic, and Pathologic Study Am. J. Respir. Crit. Care Med., March 15, 2005; 171(6): 632 - 638. [Abstract] [Full Text] [PDF]

				Y. Jegal, D. S. Kim, T. S. Shim, C.-M. Lim, S. Do Lee, Y. Koh, W. S. Kim, W. D. Kim, J. S. Lee, W. D. Travis, et al. Physiology Is a Stronger Predictor of Survival than Pathology in Fibrotic Interstitial Pneumonia Am. J. Respir. Crit. Care Med., March 15, 2005; 171(6): 639 - 644. [Abstract] [Full Text] [PDF]

				S. D. Nathan Lung Transplantation: Disease-Specific Considerations for Referral Chest, March 1, 2005; 127(3): 1006 - 1016. [Abstract] [Full Text] [PDF]

				T. S. Hallstrand, L. J. Boitano, W. C. Johnson, C. A. Spada, J. G. Hayes, and G. Raghu The timed walk test as a measure of severity and survival in idiopathic pulmonary fibrosis Eur. Respir. J., January 1, 2005; 25(1): 96 - 103. [Abstract] [Full Text] [PDF]

				T. E. King Jr, S. Safrin, K. M. Starko, K. K. Brown, P. W. Noble, G. Raghu, and D. A. Schwartz Analyses of Efficacy End Points in a Controlled Trial of Interferon-{gamma}1b for Idiopathic Pulmonary Fibrosis Chest, January 1, 2005; 127(1): 171 - 177. [Abstract] [Full Text] [PDF]

				N. Khalil and R. O'Connor Idiopathic pulmonary fibrosis: current understanding of the pathogenesis and the status of treatment Can. Med. Assoc. J., July 20, 2004; 171(2): 153 - 160. [Abstract] [Full Text] [PDF]

				H. R. Collard, J. H. Ryu, W. W. Douglas, M. I. Schwarz, D. Curran-Everett, T. E. King Jr., and K. K. Brown Combined Corticosteroid and Cyclophosphamide Therapy Does Not Alter Survival in Idiopathic Pulmonary Fibrosis Chest, June 1, 2004; 125(6): 2169 - 2174. [Abstract] [Full Text] [PDF]

				G. Thabut, M. Fournier, H. R. Collard, and K. K. Brown Prognosis in Idiopathic Pulmonary Fibrosis Am. J. Respir. Crit. Care Med., May 1, 2004; 169(9): 1075 - 1076. [Full Text] [PDF]

				M. J. Tobin Tuberculosis, Lung Infections, Interstitial Lung Disease, Social Issues and Journalology in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 288 - 300. [Full Text] [PDF]

				P. W. Noble and D. G. Morris Time Will Tell: Predicting Survival in Idiopathic Interstitial Pneumonia Am. J. Respir. Crit. Care Med., September 1, 2003; 168(5): 510 - 511. [Full Text] [PDF]