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Published ahead of print on January 7, 2005, doi:10.1164/rccm.200403-331OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 6, March 2005, 639-644

A more recent version of this article appeared on March 15, 2005
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Submitted on March 12, 2004
Accepted on December 10, 2004

Physiology is a Stronger Predictor of Survival than Pathology in Fibrotic Interstitial Pneumonia

Yangjin Jegal1, Dong Soon Kim1*, Tae Sun Shim1, Chae-Man Lim1, Sang Do Lee1, Younsuck Koh1, Woo Sung Kim1, Won Dong Kim1, Jin Seong Lee1, William D Travis2, Masanori Kitaichi3, and Thomas V Colby4

1 Division of Pulmonary and Critical Care Medicine, Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, Korea, Republic of, 2 Department of Pulmonary and Mediastinal Pathology, Armed Forces Institute of Pathology, Washington, DC, Korea, Republic of, 3 Laboratory of Anatomical Pathology, Kyoto University Hospital, Kyoto, Japan, 4 Department of Pathology, Mayo Clinic, Scottsdale, AZ, USA

* To whom correspondence should be addressed. E-mail: dskim{at}amc.seoul.kr.

The histopathologic pattern provides the most important prognostic marker for idiopathic interstitial pneumonia, however recent studies suggested that short-term changes in lung function may be more important. We investigated the prognostic factors for fibrotic interstitial pneumonia. The clinical features and follow-up course of 179 patients (131 with idiopathic pulmonary fibrosis and 48 with nonspecific interstitial pneumonia; 41 fibrotic types and seven cellular) were analyzed retrospectively. The lung function indices improved or stabilized in most patients with fibrotic nonspecific interstitial pneumonia in contrast to the deterioration or stable condition of most patients with idiopathic pulmonary fibrosis. The five-year survival of patients with fibrotic nonspecific interstitial pneumonia (76.2%) was better than for those with idiopathic pulmonary fibrosis (43.8%)(p=0.007). Multivariate analysis at the time of presentation revealed that pathologic pattern, age, diffusion capacity and gender had important prognostic implications. However, after six months of follow-up, changes in FVC, initial diffusion capacity and gender were the only independent prognostic factors, with no additional prognostic information conferred by the histologic diagnosis. Our data confirmed the importance of physiological parameters including short-term change in FVC. However at the time of diagnosis, histopathology was important for the prediction of prognosis and future change in lung function.
Key words: Fibrotic nonspecific interstitial pneumonia, idiopathic pulmonary fibrosis, pulmonary function, surgical lung biopsy, prognostic factor.




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