Radiographic fibrosis score predicts survival in hypersensitivity pneumonitis.

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

Chest

journal_title

Chest

authors

Mooney JJ,Elicker BM,Urbania TH,Agarwal MR,Ryerson CJ,Nguyen MLT,Woodruff PG,Jones KD,Collard HR,King TE Jr,Koth LL

doi

10.1378/chest.12-2623

subject

Has Abstract

pub_date

2013-08-01 00:00:00

pages

586-592

issue

2

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(13)60536-X

journal_volume

144

pub_type

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