Chest
Original ResearchDiffuse Lung DiseaseRadiographic Fibrosis Score Predicts Survival in Hypersensitivity Pneumonitis
Section snippets
Study Population
Patients with HP (n = 190) and IPF (n = 242) were prospectively enrolled from the University of California San Francisco (UCSF) Interstitial Lung Disease (ILD) Clinic from March 2000 to October 2010. Data from all patients were collected prospectively using standardized questionnaires and physician review. The diagnostic criteria for HP or IPF were based upon consensus agreement by experts at a multidisciplinary conference after thorough review of all available data in accordance with
Study Population
Baseline demographics are shown in Table 1. Compared with IPF, patients with persistent HP were younger, more likely to be female, less likely to be ever smokers, had fewer pack-years of smoking, and had less crackles on auscultatory lung examination. Patients with HP had greater physiologic obstruction (based on FEV1 and FEV1/FVC), whereas patients with IPF had greater restriction and lower diffusing capacity. Patients with HP had a lower radiographic fibrosis score (median score, 11.04 for HP
Discussion
The results from this study extend prior observations regarding the role of radiographic fibrosis in survival in patients with persistent HP and identified several novel findings. These include (1) that the radiographic fibrosis score is an independent predictor of mortality in persistent HP, (2) that patients with both fibrosis (reticulation and/or honeycombing) and auscultatory crackles on chest examination have a particularly poor outcome compared with patients with just one of these
Conclusions
We found that radiographic fibrosis, specifically the extent of fibrosis (reticulations and honeycombing), predicts worse outcome in patients with HP. The combination of reticulations on CT scan and crackles on lung examination may identify patients with a particularly poor outcome and deserves further evaluation in future HP studies. Transplant-free survival in patients with HP remains superior to that of patients with IPF with similar degrees of radiographic fibrosis. These findings highlight
Acknowledgments
Author contributions: Dr Mooney had full access to the data and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Mooney: contributed to study design; data collection and analysis; and writing, review, and approval of the final manuscript and served as principal author.
Dr Elicker: contributed to CT scan data collection and analysis and review and approval of the final manuscript.
Dr Urbania: contributed to CT scan data collection and analysis and review
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Cited by (0)
Drs Elicker, Urbania, and Agarwal contributed equally to this article.
Part of this article was presented in abstract form at the American Thoracic Society International Conference, May 18-23, 2012, San Francisco, CA (abstract 4365).
Funding/Support: This study was supported by departmental sources from the University of California San Francisco.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.