Possible UIP pattern on high-resolution computed tomography is associated with better survival than definite UIP in IPF patients

Margaret L. Salisbury, Leslie B. Tolle, Meng Xia, Susan Murray, Nabihah Tayob, Anoop M Nambiar, Shelley L. Schmidt, Amir Lagstein, Jeffery L. Myers, Barry H. Gross, Ella A. Kazerooni, Baskaran Sundaram, Aamer R. Chughtai, Fernando J. Martinez, Kevin R. Flaherty

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Background Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease of unknown etiology. Inter-society consensus guidelines on IPF diagnosis and management outline radiologic patterns including definite usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. We evaluate these diagnostic categories as prognostic markers among patients with IPF. Methods Included subjects had biopsy-proven UIP, a multidisciplinary team diagnosis of IPF, and a baseline high-resolution computed tomography (HRCT). Thoracic radiologists assigned the radiologic pattern and documented the presence and extent of specific radiologic findings. The outcome of interest was lung transplant-free survival. Results IPF patients with a possible UIP pattern on HRCT had significantly longer Kaplan-Meier event-free survival compared to those with definite UIP pattern (5.21 and 3.57 years, respectively, p = 0.002). In a multivariable Cox proportional hazards model adjusted for baseline age, gender, %-predicted FVC, and %-predicted DLCO via the GAP Stage, extent of fibrosis (via the traction bronchiectasis score) and ever-smoker status, possible UIP pattern on HRCT (versus definite UIP) was associated with reduced hazard of death or lung transplant (HR = 0.42, CI 95% 0.23–0.78, p = 0.006). Conclusions Radiologic diagnosis categories outlined by inter-society consensus guidelines is a widely-reported and potentially useful prognostic marker in IPF patients, with possible UIP pattern on HRCT associated with a favorable prognosis compared to definite UIP pattern, after adjusting for relevant covariates.

Original languageEnglish (US)
Pages (from-to)229-235
Number of pages7
JournalRespiratory Medicine
Volume131
DOIs
StatePublished - Oct 1 2017

Fingerprint

Idiopathic Pulmonary Fibrosis
Tomography
Survival
Guidelines
Transplants
Lung
Bronchiectasis
Traction

Keywords

  • High resolution computed tomography
  • Prognosis
  • Pulmonary fibrosis
  • Usual interstitial pneumonia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Possible UIP pattern on high-resolution computed tomography is associated with better survival than definite UIP in IPF patients. / Salisbury, Margaret L.; Tolle, Leslie B.; Xia, Meng; Murray, Susan; Tayob, Nabihah; Nambiar, Anoop M; Schmidt, Shelley L.; Lagstein, Amir; Myers, Jeffery L.; Gross, Barry H.; Kazerooni, Ella A.; Sundaram, Baskaran; Chughtai, Aamer R.; Martinez, Fernando J.; Flaherty, Kevin R.

In: Respiratory Medicine, Vol. 131, 01.10.2017, p. 229-235.

Research output: Contribution to journalArticle

Salisbury, ML, Tolle, LB, Xia, M, Murray, S, Tayob, N, Nambiar, AM, Schmidt, SL, Lagstein, A, Myers, JL, Gross, BH, Kazerooni, EA, Sundaram, B, Chughtai, AR, Martinez, FJ & Flaherty, KR 2017, 'Possible UIP pattern on high-resolution computed tomography is associated with better survival than definite UIP in IPF patients', Respiratory Medicine, vol. 131, pp. 229-235. https://doi.org/10.1016/j.rmed.2017.08.025
Salisbury, Margaret L. ; Tolle, Leslie B. ; Xia, Meng ; Murray, Susan ; Tayob, Nabihah ; Nambiar, Anoop M ; Schmidt, Shelley L. ; Lagstein, Amir ; Myers, Jeffery L. ; Gross, Barry H. ; Kazerooni, Ella A. ; Sundaram, Baskaran ; Chughtai, Aamer R. ; Martinez, Fernando J. ; Flaherty, Kevin R. / Possible UIP pattern on high-resolution computed tomography is associated with better survival than definite UIP in IPF patients. In: Respiratory Medicine. 2017 ; Vol. 131. pp. 229-235.
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abstract = "Background Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease of unknown etiology. Inter-society consensus guidelines on IPF diagnosis and management outline radiologic patterns including definite usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. We evaluate these diagnostic categories as prognostic markers among patients with IPF. Methods Included subjects had biopsy-proven UIP, a multidisciplinary team diagnosis of IPF, and a baseline high-resolution computed tomography (HRCT). Thoracic radiologists assigned the radiologic pattern and documented the presence and extent of specific radiologic findings. The outcome of interest was lung transplant-free survival. Results IPF patients with a possible UIP pattern on HRCT had significantly longer Kaplan-Meier event-free survival compared to those with definite UIP pattern (5.21 and 3.57 years, respectively, p = 0.002). In a multivariable Cox proportional hazards model adjusted for baseline age, gender, {\%}-predicted FVC, and {\%}-predicted DLCO via the GAP Stage, extent of fibrosis (via the traction bronchiectasis score) and ever-smoker status, possible UIP pattern on HRCT (versus definite UIP) was associated with reduced hazard of death or lung transplant (HR = 0.42, CI 95{\%} 0.23–0.78, p = 0.006). Conclusions Radiologic diagnosis categories outlined by inter-society consensus guidelines is a widely-reported and potentially useful prognostic marker in IPF patients, with possible UIP pattern on HRCT associated with a favorable prognosis compared to definite UIP pattern, after adjusting for relevant covariates.",
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T1 - Possible UIP pattern on high-resolution computed tomography is associated with better survival than definite UIP in IPF patients

AU - Salisbury, Margaret L.

AU - Tolle, Leslie B.

AU - Xia, Meng

AU - Murray, Susan

AU - Tayob, Nabihah

AU - Nambiar, Anoop M

AU - Schmidt, Shelley L.

AU - Lagstein, Amir

AU - Myers, Jeffery L.

AU - Gross, Barry H.

AU - Kazerooni, Ella A.

AU - Sundaram, Baskaran

AU - Chughtai, Aamer R.

AU - Martinez, Fernando J.

AU - Flaherty, Kevin R.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Background Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease of unknown etiology. Inter-society consensus guidelines on IPF diagnosis and management outline radiologic patterns including definite usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. We evaluate these diagnostic categories as prognostic markers among patients with IPF. Methods Included subjects had biopsy-proven UIP, a multidisciplinary team diagnosis of IPF, and a baseline high-resolution computed tomography (HRCT). Thoracic radiologists assigned the radiologic pattern and documented the presence and extent of specific radiologic findings. The outcome of interest was lung transplant-free survival. Results IPF patients with a possible UIP pattern on HRCT had significantly longer Kaplan-Meier event-free survival compared to those with definite UIP pattern (5.21 and 3.57 years, respectively, p = 0.002). In a multivariable Cox proportional hazards model adjusted for baseline age, gender, %-predicted FVC, and %-predicted DLCO via the GAP Stage, extent of fibrosis (via the traction bronchiectasis score) and ever-smoker status, possible UIP pattern on HRCT (versus definite UIP) was associated with reduced hazard of death or lung transplant (HR = 0.42, CI 95% 0.23–0.78, p = 0.006). Conclusions Radiologic diagnosis categories outlined by inter-society consensus guidelines is a widely-reported and potentially useful prognostic marker in IPF patients, with possible UIP pattern on HRCT associated with a favorable prognosis compared to definite UIP pattern, after adjusting for relevant covariates.

AB - Background Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing lung disease of unknown etiology. Inter-society consensus guidelines on IPF diagnosis and management outline radiologic patterns including definite usual interstitial pneumonia (UIP), possible UIP, and inconsistent with UIP. We evaluate these diagnostic categories as prognostic markers among patients with IPF. Methods Included subjects had biopsy-proven UIP, a multidisciplinary team diagnosis of IPF, and a baseline high-resolution computed tomography (HRCT). Thoracic radiologists assigned the radiologic pattern and documented the presence and extent of specific radiologic findings. The outcome of interest was lung transplant-free survival. Results IPF patients with a possible UIP pattern on HRCT had significantly longer Kaplan-Meier event-free survival compared to those with definite UIP pattern (5.21 and 3.57 years, respectively, p = 0.002). In a multivariable Cox proportional hazards model adjusted for baseline age, gender, %-predicted FVC, and %-predicted DLCO via the GAP Stage, extent of fibrosis (via the traction bronchiectasis score) and ever-smoker status, possible UIP pattern on HRCT (versus definite UIP) was associated with reduced hazard of death or lung transplant (HR = 0.42, CI 95% 0.23–0.78, p = 0.006). Conclusions Radiologic diagnosis categories outlined by inter-society consensus guidelines is a widely-reported and potentially useful prognostic marker in IPF patients, with possible UIP pattern on HRCT associated with a favorable prognosis compared to definite UIP pattern, after adjusting for relevant covariates.

KW - High resolution computed tomography

KW - Prognosis

KW - Pulmonary fibrosis

KW - Usual interstitial pneumonia

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U2 - 10.1016/j.rmed.2017.08.025

DO - 10.1016/j.rmed.2017.08.025

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JO - Respiratory Medicine

JF - Respiratory Medicine

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