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Prognostic Implications of Physiologic and Radiographic Changes in Idiopathic Interstitial Pneumonia

Departments of Radiology and Pathology, Division of Pulmonary and Critical Care Medicine, University of Michigan Health System; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; Armed Forces Institute of Pathology, Washington, District of Columbia; and Mayo Clinic, Scottsdale, Arizona

Correspondence and requests for reprints should be addressed to Fernando J. Martinez, M.D., M.S., Taubman Center 3916, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0360. E-mail: fmartine{at}umich.edu

Idiopathic interstitial pneumonias are a diverse group of lung diseases with varied prognoses. We hypothesized that changes in physiologic and radiographic parameters would predict survival. We retrospectively examined 80 patients with usual interstitial pneumonia and 29 patients with nonspecific interstitial pneumonia. Baseline characteristics were examined together with 6-month change in forced vital capacity, diffusing capacity for carbon monoxide, and ground glass infiltrate and fibrosis on high resolution computed tomography. Patients with usual interstitial pneumonia were more likely to have a statistically significant or marginally significant decline in lung volume, diffusing capacity for carbon monoxide, and an increase in ground glass infiltrates (p 0.08) compared with patients with nonspecific interstitial pneumonia. For patients with usual interstitial pneumonia, change in forced vital capacity was the best physiologic predictor of mortality (p = 0.05). In a multivariate Cox proportional hazards model controlling for histopathologic diagnosis, gender, smoking history, baseline forced vital capacity, and 6-month change in forced vital capacity, a decrease in forced vital capacity remained an independent risk factor for mortality (decrease > 10%; hazard ratio 2.47; 95% confidence interval 1.29, 4.73; p = 0.006). We conclude that a 6-month change in forced vital capacity gives additional prognostic information to baseline features for patients with idiopathic interstitial pneumonia.

Key Words: idiopathic pulmonary fibrosis • usual interstitial pneumonia • nonspecific interstitial pneumonia • pulmonary function • serial testing

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