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Published ahead of print on July 6, 2006, doi:10.1164/rccm.200604-488OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 7, October 2006, 803-809

A more recent version of this article appeared on October 1, 2006
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Submitted on April 6, 2006
Accepted on June 30, 2006

Idiopathic Pulmonary Fibrosis: Prognostic Value of Changes in Physiology and Six Minute Hallwalk

Kevin R Flaherty1*, Adin-Cristian Andrei2, Susan Murray2, Chris Fraley1, Thomas V Colby3, William D Travis4, Vibha Lama1, Ella A Kazerooni5, Barry H Gross5, Galen B Toews1, and Fernando J Martinez1

1 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA, 2 Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA, 3 Department of Pathology, Mayo Clinic, Scottsdale, AZ, USA, 4 Department of Pathology, Memorial Sloan Kettering, New York, NY, USA, 5 Department of Radiology, University of Michigan Health System, Ann Arbor, MI, USA

* To whom correspondence should be addressed. E-mail: flaherty{at}umich.edu.

Rationale and hypothesis: Idiopathic pulmonary fibrosis is a fatal disease with a variable rate of progression. We hypothesized that changes in distance walked and quantity of desaturation during a six minute walk test would add prognostic information to changes in forced vital capacity or diffusing capacity for carbon monoxide. Methods: One hundred and ninety-seven patients with idiopathic pulmonary fibrosis were evaluated. Desaturation during the six minute hallwalk was associated with increased mortality even if a threshold of 88% was not reached. Baseline walk distance predicted subsequent walk distance but was not a reliable predictor of subsequent mortality in multivariate survival models. The predictive ability of serial changes in physiology varied when patients were stratified by the presence/absence of desaturation ≤ 88% during a baseline six minute walk test. For patients with a baseline saturation ≤ 88% during a six minute walk test the strongest observed predictor of mortality was serial change in diffusing capacity for carbon monoxide. For patients with saturation > 88% during their baseline walk test serial decreases in forced vital capacity and increases in desaturation area, significantly predicted subsequent mortality while decreases in walk distance and in diffusing capacity for carbon monoxide displayed less consistent statistical evidence of increasing mortality in our patients. Conclusion: These data highlight the importance of stratifying patients by degree of desaturation during a six minute walk test prior to attributing prognostic value to serial changes in other physiologic variables.
Key words: Idiopathic pulmonary fibrosis, six minute hall walk, prognosis, survival, pulmonary function




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