Predictors of idiopathic pulmonary fibrosis in absence of radiologic honeycombing: A cross sectional analysis in ILD patients undergoing lung tissue sampling
Predictors of idiopathic pulmonary fibrosis in absence of radiologic honeycombing: A cross sectional analysis in ILD patients undergoing lung tissue sampling
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DOI：
10.1016/j.rmed.2016.07.016
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发表时间：
2016-09-01
影响因子：
4.3
通讯作者：
Flaherty, Kevin R.
中科院分区：
文献类型：
--
作者：
Salisbury, Margaret L.;Xia, Meng;Flaherty, Kevin R.
背景资料：当符合临床和计算机断层扫描（CT）标准时，特发性肺纤维化（IPF）可以被自信地和非侵入性地诊断。许多不符合这些标准，由于缺乏CI'蜂窝。我们研究了IPF的预测因子和组合，允许准确诊断的个人没有honeycombing.Methods：我们利用前瞻性收集的临床和CT数据，从患者登记在肺组织研究联盟。纳入的患者无蜂窝样改变，无结缔组织病，接受了诊断性肺活检，CT模式与纤维化ILD一致（n = 200）。Logistic回归确定了预测IPF的临床和CT变量。在重要临床和CT变量的不同临界点评估IPF的概率。根据年龄和性别调整的多变量模型发现网状密度越来越大（OR 2.93，CI 95% 1.55-5.56，p = 0.001）预测IPF，而毛玻璃密度增加预测IPF以外的诊断（OR 0.55，CI 95% 0.34-0.89，p = 0.02）。在年龄至少60岁且网状密度范围等于或大于总肺体积的三分之一的患者中，IPF的基于模型的概率为80%或更高;对于满足或超过这些临床阈值的患者，IPF的特异性为96%结论：在疑似纤维化ILD且CT无蜂窝样改变的患者中，网状和毛玻璃密度的范围可预测IPF的诊断。在年龄超过60岁且总肺的三分之一具有网状密度的受试者中，IPF的概率超过80%。(C)2016爱思唯尔有限公司版权所有
Background: Idiopathic pulmonary fibrosis (IPF) can be diagnosed confidently and non-invasively when clinical and computed tomography (CT) criteria are met. Many do not meet these criteria due to absence of CI' honeycombing. We investigated predictors of IPF and combinations allowing accurate diagnosis in individuals without honeycombing.Methods: We utilized prospectively collected clinical and.CT data from patients enrolled in the Lung Tissue Research Consortium. Included patients had no honeycombing, no connective tissue disease, underwent diagnostic lung biopsy, and had CT pattern consistent with fibrosing ILD (n = 200). Logistic regression identified clinical and CT variables predictive of IPF. The probability of IPF was assessed at various cut-points of important clinical and CT variables.Results: A multivariable model adjusted for age and gender found increasingly extensive reticular densities (OR 2.93, CI 95% 1.55-5.56, p = 0.001) predicted IPF, while increasing ground glass densities predicted a diagnosis other than IPF (OR 0.55, CI 95% 0.34-0.89, p = 0.02). The model-based probability of IPF was 80% or greater in patients with age at least 60 years and extent of reticular density one-third or more of total lung volume; for patients meeting or exceeding these clinical thresholds the specificity for IPF is 96% (CI 95% 91-100%) with 21 of 134 (16%) biopsies avoided.Conclusions: In patients with suspected fibrotic ILD and absence of CT honeycombing, extent of reticular and ground glass densities predict a diagnosis of IPF. The probability of IPF exceeds 80% in subjects over age 60 years with one-third of total lung having reticular densities. (C) 2016 Elsevier Ltd. All rights reserved.