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Published ahead of print on June 15, 2006, doi:10.1164/rccm.200604-520OC

Am. J. Respir. Crit. Care Med., Volume 174, Number 6, September 2006, 659-664

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Submitted on April 12, 2006
Accepted on June 14, 2006

Six-Minute Walk Distance Predicts Waiting List Survival in Idiopathic Pulmonary Fibrosis

David J Lederer1, Selim M Arcasoy1, Jessie S Wilt1, Frank D'Ovidio2, Joshua R Sonett2, and Steven M Kawut3*

1 Department of Medicine, Columbia University, New York, NY, USA, 2 College of Physicians and Surgeons, Department of Surgery, Columbia University, New York, NY, USA, 3 Department of Medicine, Columbia University, New York, NY, USA; Department of Epidemiology, Columbia University, Joseph L. Mailman School of Public Health, New York, NY, USA

* To whom correspondence should be addressed. E-mail: sk2097{at}columbia.edu.

Rationale: Functional studies may be useful to predict survival in idiopathic pulmonary fibrosis. Various cutoffs of six-minute walk distance have been suggested to identify patients at a high risk of death. Objectives: To examine the association between six-minute walk distance and survival in patients with idiopathic pulmonary fibrosis listed for lung transplantation. To identify sensitive and specific cutoffs for predicting death at six months. Methods: We performed a retrospective cohort study of 454 patients classified as having idiopathic pulmonary fibrosis listed for lung transplantation with the United Network for Organ Sharing between June 30, 2004 and July 22, 2005. Measurements and Main Results: Lower six-minute walk distance was associated with an increased mortality rate (p value for linear trend < 0.0001). Patients with a walk distance < 207 meters had a more than four-fold greater mortality rate than those with a walk distance ≥ 207 meters despite adjustment for demographics, anthropomorphics, forced vital capacity percent predicted, pulmonary hypertension, and medical comorbidities (adjusted rate ratio = 4.7, 95% confidence interval 2.5 to 8.9, p < 0.0001). Six-minute walk distance was a significantly better predictor of six-month mortality than forced vital capacity percent predicted (c-statistic = 0.73 versus 0.59, respectively, p = 0.02). Conclusions: Lower six-minute walk distance was strongly and independently associated with an increased mortality rate for wait-listed patients classified as having idiopathic pulmonary fibrosis. Six-minute walk distance was a better predictor of death at six months than forced vital capacity percent predicted.
Key words: Lung Diseases, Interstitial; Exercise Test; Lung transplantation; Cohort




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