Physiology is a better predictor of mortality than HRTC findings in patients with fibrotic idiopathic interstitial pneumonia

Background: Prognosis of fibrotic idiopathic interstitial pneumonia (IIP) is influenced not only by the histologic pattern observed in lung biopsy but also by high resolution chest tomography (HRCT) and pulmonary function findings. Aim: To evaluate if functional parameters are better predictors of mortality that HRCT findings in patients with fibrotic IIP. Methods: We studied 43 patients with fibrotic IIP during a follow-up of 37.2±31.7 months after diagnosis. Baseline HRCT was evaluated for different abnormalities: honeycombing (HC), reticulation, ground-glass, bronchiectasis and total fibrotic score. Pulmonary function was assessed as baseline FVC and change of FVC after 6 months of follow-up (less or more 10%). Results: Among the different HRCT scores, a cut-off of 10% in the HC score differentiated patients with different survival (5-yrs survival 41% vs 90%, p=0.04). Patients with HC > 10% had a longer duration of symptoms (p=0.04), a lower baseline DLCO (% of predicted, p=0.006) and higher fibrotic and bronchiectasis score (respectively, p=0.04 and p Conclusion: Functional findings are more important prognostic factors of mortality than HRCT parameters in patients with fibrotic IIP.