Predictors of survival in idiopathic interstitial pneumonia

R. Carbone 1, G. Bottino 2, P. Paredi 3, P. Shah 3, K.C. Meyer 4

1 Department of Medicine, Respiratory Unit, Regional Hospital Aosta, Aosta (Italy) 2 DI.MI. University of Genoa, Genoa (Italy) 3 National Heart and Lung Institute, Royal Brompton Hospital, London (United Kingdom) 4 Department of Medicine, Section of Allergy, Pulmonary, and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health (USA)

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• Respiratory Medicine

Aim: To evaluate the ability of newly identified clinical factors to predict prognosis and survival in idiopathic pulmonary fibrosis (IPF) and non-specific interstitial pneumonia (NSIP).

Methods: Seventy-eight patients referred to the University of Genoa and the Regional Hospital of Aosta between January 1995 and December 2006 were evaluated prospectively. Fifty-nine patients were diagnosed with IPF and 19 with NSIP on the basis of surgical lung biopsy specimens. Gender, age at diagnosis, smoking, New York Heart Association class (NYHA), systolic pulmonary artery pressure (sPAP), Octreoscan uptake index (UI), and therapy were the chosen variables. Primary end-point was survival.

Results: With the exception of gender and smoking history, all baseline patient characteristics correlated significantly with the diagnosis (IPF vs. NSIP). Median survival for the entire study group was 52.7 months. Univariate analysis showed poorer survival for the IPF group versus the NSIP group, and survival was significantly lower for older patients (p < 0.001). Multivariate analysis confirmed the negative prognostic effect of age (p < 0.001) on survival with a risk of death for older patients (≥66 years old) being more than 4 times higher than that for younger patients (< 58 yr.). NYHA class and pulmonary artery pressure were also significant predictors of survival, and all patients with a sPAP ≤ 35-mm Hg were alive at the end of the follow-up period. There was a good correlation between Octreoscan uptake index and the diagnosis.

Conclusion: Diagnosis (IPF vs. NSIP), NYHA class, sPAP, and especially age appear to represent important prognostic indicators in the two most prevalent forms of idiopathic pulmonary fibrosis (IPF and NSIP). Lower Octreoscan uptake values were found in all patients with IPF, suggesting that this test may have a role as a new predictor of survival for differentiating IPF from NSIP.

Corresponding Author: Keith C. Meyer, MD; e-mail: kcm@medicine.wisc.edu

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