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Imaging Patterns Are Associated with Interstitial Lung Abnormality Progression and Mortality

医学 危险系数 置信区间 优势比 比例危险模型 寻常性间质性肺炎 肺炎 放射科 内科学 特发性肺纤维化
作者
Rachel K. Putman,Gunnar Guðmundsson,Gísli Thor Axelsson,Tomoyuki Hida,Osamu Honda,Toshimitsu Araki,Masahiro Yanagawa,Mizuki Nishino,Ezra R. Miller,Guðný Eiríksdóttir,Elías F. Guðmundsson,Noriyuki Tomiyama,Hiroshi Honda,Iván O. Rosas,George R. Washko,Michael H. Cho,David A. Schwartz,Vilmundur Gudnason,Hiroto Hatabu,Gary M. Hunninghake
出处
期刊:American Journal of Respiratory and Critical Care Medicine [American Thoracic Society]
卷期号:200 (2): 175-183 被引量:152
标识
DOI:10.1164/rccm.201809-1652oc
摘要

Rationale: Interstitial lung abnormalities (ILA) are radiologic abnormalities on chest computed tomography scans that have been associated with an early or mild form of pulmonary fibrosis. Although ILA have been associated with radiologic progression, it is not known if specific imaging patterns are associated with progression or risk of mortality.Objectives: To determine the role of imaging patterns on the risk of death and ILA progression.Methods: ILA (and imaging pattern) were assessed in 5,320 participants from the AGES-Reykjavik Study, and ILA progression was assessed in 3,167 participants. Multivariable logistic regression was used to assess factors associated with ILA progression, and Cox proportional hazards models were used to assess time to mortality.Measurements and Main Results: Over 5 years, 327 (10%) had ILA on at least one computed tomography, and 1,435 (45%) did not have ILA on either computed tomography. Of those with ILA, 238 (73%) had imaging progression, whereas 89 (27%) had stable to improved imaging; increasing age and copies of MUC5B genotype were associated with imaging progression. The definite fibrosis pattern was associated with the highest risk of progression (odds ratio, 8.4; 95% confidence interval, 2.7–25; P = 0.0003). Specific imaging patterns were also associated with an increased risk of death. After adjustment, both a probable usual interstitial pneumonia and usual interstitial pneumonia pattern were associated with an increased risk of death when compared with those indeterminate for usual interstitial pneumonia (hazard ratio, 1.7; 95% confidence interval, 1.2–2.4; P = 0.001; hazard ratio, 3.9; 95% confidence interval, 2.3–6.8;P < 0.0001), respectively.Conclusions: In those with ILA, imaging patterns can be used to help predict who is at the greatest risk of progression and early death.

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