Abstract:
BACKGROUND:It is unknown if the radiographic fibrosis score predicts mortality in persistent hypersensitivity pneumonitis (HP) and if survival is similar to that observed in idiopathic pulmonary fibrosis (IPF) when adjusting for the extent of radiographic fibrosis. METHODS:We reviewed records from 177 patients with HP and 224 patients with IPF whose diagnoses were established by multidisciplinary consensus. Two thoracic radiologists scored high-resolution CT (HRCT) scan lung images. Independent predictors of transplant-free survival were determined using a Cox proportional hazards analysis. Kaplan-Meier survival curves were constructed, stratified by disease as well as fibrosis score. RESULTS:HRCT scan fibrosis score and radiographic reticulation independently predicted time to death or lung transplantation. Clinical predictors included a history of cigarette smoking, auscultatory crackles on lung examination, baseline FVC, and FEV1/FVC ratio. The majority of HP deaths occurred in patients with both radiographic reticulation and auscultatory crackles on examination, compared with patients with only one of these manifestations (P < .0001). Patients with IPF had worse survival than those with HP at any given degree of radiographic fibrosis (hazard ratio 2.31; P < .01). CONCLUSIONS:Survival in patients with HP was superior to that of those with IPF with similar degrees of radiographic fibrosis. The combination of auscultatory crackles and radiographic reticulation identified patients with HP who had a particularly poor outcome.
journal_name
Chestjournal_title
Chestauthors
Mooney JJ,Elicker BM,Urbania TH,Agarwal MR,Ryerson CJ,Nguyen MLT,Woodruff PG,Jones KD,Collard HR,King TE Jr,Koth LLdoi
10.1378/chest.12-2623subject
Has Abstractpub_date
2013-08-01 00:00:00pages
586-592issue
2eissn
0012-3692issn
1931-3543pii
S0012-3692(13)60536-Xjournal_volume
144pub_type
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