Computed tomography patterns predict clinical course of idiopathic pulmonary fibrosis

• Published in: Respiratory research Vol. 21; no. 1; pp. 1 - 295
• Main Authors: Kwon, Byoung Soo, Choe, Jooae, Do, Kyung Hyun, Hwang, Hee Sang, Chae, Eun Jin, Song, Jin Woo
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 10.11.2020; BioMed Central; BMC
• Subjects: Age; Biopsy; Care and treatment; CAT scans; Computed tomography; Confidence intervals; Development and progression; Diagnostic systems; Fibrosis; Guideline; Idiopathic pulmonary fibrosis; Lung cancer; Lung diseases; Lungs; Medical prognosis; Methods; Pneumonia; Prognosis; Pulmonary fibrosis; Pulmonary function tests; Respiratory function; Respiratory function test; Survival; Survival analysis; Variables; South Korea
• DOI: 10.1186/s12931-020-01562-2
• ISSN: 1465-993X; 1465-9921

Abstract Background A new clinical guideline for idiopathic pulmonary fibrosis (IPF) uses high-resolution computed tomography (HRCT) patterns for diagnostic purposes. However, it is unknown how they relate to the IPF clinical course. We aimed to investigate whether HRCT patterns could be used to predict lung function changes and survival in patients with IPF. Methods Clinical data were retrospectively reviewed in 337 patients with IPF (all biopsy-proven cases). HRCT patterns were classified according to the 2018 IPF diagnostic criteria. Results The median follow-up was 46.9 months. The mean age was 62.5 years, and 74.2% were men. Among the HRCT patterns, usual interstitial pneumonia (UIP), probable UIP, indeterminate for UIP, and an alternative diagnosis were identified in 163 (48.4%), 110 (32.6%), 33 (9.8%), and 31 (9.2%) patients, respectively. The indeterminate for UIP group showed higher lung function and exercise capacity and better prognosis than the other groups. They also had a lesser decline in lung function than the other groups during follow-up. In the multivariate Cox analysis, which was adjusted by age, smoking status, lung function, exercise capacity, and use of antifibrotic agents, indeterminate for UIP pattern was found to be an independent prognostic factor (hazard ratio 0.559, 95% confidence interval 0.335–0.933, P  = 0.026). However, the probable UIP group had similar lung function changes and prognosis when compared the UIP group. Conclusions Our results suggest that indeterminate for UIP pattern on HRCT may predict a more favorable clinical course in patients with IPF, supporting the validity of the new IPF diagnostic guidelines.