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Idiopathic Pulmonary Fibrosis

Prognostic Value of Changes in Physiology and Six-Minute-Walk Test

Division of Pulmonary and Critical Care Medicine and the Department of Radiology, University of Michigan Health System, Ann Arbor; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Pathology, Mayo Clinic, Scottsdale, Arizona; and Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York

Correspondence and requests for reprints should be addressed to Kevin R. Flaherty, M.D., M.S., Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, 1500 East Medical Center Drive, 3916 Taubman Center, Ann Arbor, MI 48109. 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 (6MWT) would add prognostic information to changes in FVC or diffusing capacity for carbon monoxide.

Methods: One hundred ninety-seven patients with idiopathic pulmonary fibrosis were evaluated. Desaturation during the 6MWT 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 6MWT. For patients with a baseline saturation 88% during a 6MWT, 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 FVC and increases in desaturation area significantly predicted subsequent mortality, whereas 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 6MWT before attributing prognostic value to serial changes in other physiologic variables.

Key Words: idiopathic pulmonary fibrosis • six-minute-walk test • prognosis • pulmonary function • survival

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