T Diridollou1, L Sohier2, C Rousseau3, A Angibaud4, P Chauvin4, T Gaignon4, M Tas5, J Lemerre5, M Kerjouan4, A Salé4, M Lederlin5, S Jouneau6. 1. Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France. Electronic address: thomas.diridollou@gmail.com. 2. Service de pneumologie, centre hospitalier Lorient, Lorient, France. 3. Centre d'investigation clinique, Inserm 1414, Rennes, France. 4. Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France. 5. Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France. 6. Service de pneumologie, centre de compétences pour les maladies rares pulmonaires, CHU de Rennes, France, Université de Rennes 1, Rennes, France; Service de pneumologie, centre hospitalier Lorient, Lorient, France; Centre d'investigation clinique, Inserm 1414, Rennes, France; Service de radiologie, CHU de Rennes, France, université de Rennes 1, Rennes, France; UMR1085, IRSET, université de Rennes 1, Rennes, France. Electronic address: stephane.jouneau@chu-rennes.fr.
Abstract
INTRODUCTION: The new 2018 international guidelines for diagnosing usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) by CT scan split the old pattern possible UIP (2011 IPF guidelines) into two new patterns: probable UIP and indeterminate for UIP. However, the proportions and prognoses of these new CT-scan patterns are not clear. METHODS: We used a monocentric retrospective cohort of 322 patients suspected of having IPF (University Hospital of Rennes; Competence Center for Rare Lung Diseases; 1 January 2012-31 December 2017). All patients initially diagnosed by CT scan as possible UIP were included. The chest CT-scans were then reclassified according to the new 2018 international guidelines by 3 observers. These data were then subjected to survival analysis with multivariate Cox regression using a composite endpoint of death, lung transplantation, a decline of≥10% in forced vital capacity (FVC), or hospitalization. RESULTS: Of the 89 possible UIP patients included, 74 (83%) were reclassified as probable UIP and 15 (17%) as indeterminate for UIP. Probable UIP patients were more likely to meet the composite endpoint (56/74 [75.7%] vs. 5/15 [33%] patients; HR [IC 95%] =3.12 [1.24; 7.83], P=0.015). Multivariate analysis indicated that the probable UIP pattern was associated with significantly increased risk of reaching the composite endpoint (HR [95% CI]=2.85[1.00; 8.10], P=0.049). CONCLUSION: The majority of possible UIP diagnoses corresponded to probable UIP, which was associated with a significantly worse prognosis than indeterminate for UIP. This distinction between these two CT patterns emphasizes the relevance of the new international guidelines for the diagnosis of IPF.
INTRODUCTION: The new 2018 international guidelines for diagnosing usual interstitial pneumonia (UIP)/idiopathic pulmonary fibrosis (IPF) by CT scan split the old pattern possible UIP (2011 IPF guidelines) into two new patterns: probable UIP and indeterminate for UIP. However, the proportions and prognoses of these new CT-scan patterns are not clear. METHODS: We used a monocentric retrospective cohort of 322 patients suspected of having IPF (University Hospital of Rennes; Competence Center for Rare Lung Diseases; 1 January 2012-31 December 2017). All patients initially diagnosed by CT scan as possible UIP were included. The chest CT-scans were then reclassified according to the new 2018 international guidelines by 3 observers. These data were then subjected to survival analysis with multivariate Cox regression using a composite endpoint of death, lung transplantation, a decline of≥10% in forced vital capacity (FVC), or hospitalization. RESULTS: Of the 89 possible UIP patients included, 74 (83%) were reclassified as probable UIP and 15 (17%) as indeterminate for UIP. Probable UIP patients were more likely to meet the composite endpoint (56/74 [75.7%] vs. 5/15 [33%] patients; HR [IC 95%] =3.12 [1.24; 7.83], P=0.015). Multivariate analysis indicated that the probable UIP pattern was associated with significantly increased risk of reaching the composite endpoint (HR [95% CI]=2.85[1.00; 8.10], P=0.049). CONCLUSION: The majority of possible UIP diagnoses corresponded to probable UIP, which was associated with a significantly worse prognosis than indeterminate for UIP. This distinction between these two CT patterns emphasizes the relevance of the new international guidelines for the diagnosis of IPF.
Authors: Federica Maccarinelli; Mattia Bugatti; Ander Churruca Schuind; Sara Ganzerla; William Vermi; Marco Presta; Roberto Ronca Journal: Front Immunol Date: 2021-02-18 Impact factor: 7.561
Authors: Andrew Achaiah; Amila Rathnapala; Andrea Pereira; Harriet Bothwell; Kritica Dwivedi; Rosie Barker; Rachel Benamore; Rachel K Hoyles; Valentina Iotchkova; Ling-Pei Ho Journal: BMJ Open Respir Res Date: 2021-11