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Published ahead of print on August 13, 2003, doi:10.1164/rccm.200302-219OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 9, November 2003, 1084-1090

A more recent version of this article appeared on November 1, 2003
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Submitted on February 14, 2003
Accepted on August 7, 2003

Prognostic Value of Desaturation During a Six Minute Walk Test In Idiopathic Interstitial Pneumonia

Vibha N Lama1, Kevin R Flaherty1, Galen B Toews1, Thomas V Colby2, William D Travis3, Qi Long4, Susan Murray4, Ella A Kazerooni5, Barry H Gross5, Joseph P Lynch III1, and Fernando J Martinez1*

1 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI, USA, 2 Pathology, Mayo Clinic, Scottsdale, AZ, USA, 3 Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC, USA, 4 Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA, 5 Radiology, University of Michigan, Ann Arbor, MI, USA

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

Exercise induced hypoxia is an index of the severity of interstitial lung disease. We hypothesized that desaturation during a six minute walk test would predict mortality for patients with usual interstitial pneumonia (n=83) and non-specific interstitial pneumonia (n=22). Consecutive patients with biopsy-proven disease performed a six minute walk test between 01/96 and 12/2001. Desaturation was defined as a fall in oxygen saturation <=88% during the six-minute walk test. Desaturation was common (44/83 usual interstitial pneumonia, 8/22 non-specific interstitial pneumonia; chi-square p=0.39). Patients with usual interstitial pneumonia or non-specific interstitial pneumonia who desaturated had a significantly higher mortality than patients who did not desaturate (respective log-rank tests p=0.0018, p= 0.0089). In patients with usual interstitial pneumonia, the presence of desaturation was associated with an increased hazard of death (hazard ratio 4.2, 95% CI 1.40 - 12.56, p=0.01), after adjusting for age, gender, smoking, baseline diffusion capacity for carbon monoxide, forced vital capacity and resting saturation. We conclude that knowledge of desaturation during a six-minute walk test adds prognostic information for patients with usual interstitial pneumonia and nonspecific interstitial pneumonia.
Key words: usual interstitial pneumonia, non-specific interstitial pneumonia, desaturation




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