Prevalence and prognosis of unclassifiable interstitial lung disease.

TitlePrevalence and prognosis of unclassifiable interstitial lung disease.
Publication TypeJournal Article
Year of Publication2013
AuthorsRyerson, CJ, Urbania, TH, Richeldi, L, Mooney, JJ, Lee, JS, Jones, KD, Elicker, BM, Koth, LL, King, TE, Wolters, PJ, Collard, HR
JournalEur Respir J
Volume42
Issue3
Pagination750-7
Date Published2013 Sep
ISSN1399-3003
KeywordsAged, Aged, 80 and over, Biopsy, Case-Control Studies, Cohort Studies, Disease Progression, Female, Humans, Idiopathic Pulmonary Fibrosis, Kaplan-Meier Estimate, Longitudinal Studies, Lung, Lung Diseases, Interstitial, Male, Middle Aged, Prevalence, Prognosis, Proportional Hazards Models, Pulmonary Diffusing Capacity, Risk Factors, Severity of Illness Index, Smoking, Survival Rate, Tomography, X-Ray Computed, Vital Capacity
Abstract

The aim of this study was to determine the prevalence, characteristics and outcomes of patients with unclassifiable interstitial lung disease (ILD) and to develop a simple method of predicting disease behaviour. Unclassifiable ILD patients were identified from an ongoing longitudinal cohort. Unclassifiable ILD was diagnosed after a multidisciplinary review did not secure a specific ILD diagnosis. Clinical characteristics and outcomes were compared with idiopathic pulmonary fibrosis (IPF) and non-IPF ILDs. Independent predictors of mortality were determined using Cox proportional-hazards analysis to identify subgroups with distinct disease behaviour. Unclassifiable ILD was diagnosed in 10% of the ILD cohort (132 out of 1370 patients). The most common reason for being unclassifiable was missing histopathological assessment due to a high risk of surgical lung biopsy. Demographic and physiological features of unclassifiable ILD were intermediate between IPF and non-IPF disease controls. Unclassifiable ILD had longer survival rates when compared to IPF on adjusted analysis (hazard ratio 0.62, p = 0.04) and similar survival compared to non-IPF ILDs (hazard ratio 1.54, p = 0.12). Independent predictors of survival in unclassifiable ILD included diffusion capacity of the lung for carbon monoxide (p = 0.001) and a radiological fibrosis score (p = 0.02). Unclassifiable ILD represents approximately 10% of ILD cases and has a heterogeneous clinical course, which can be predicted using clinical and radiological variables.

DOI10.1183/09031936.00131912
Alternate JournalEur. Respir. J.
PubMed ID23222877