PURPOSE: To evaluate the clinical utility of various prognostic values of survival in usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP).
METHODS: 106 patients diagnosed (73 UIP and 33 NSIP: 23 fibrotic and 10 cellular type) were analyzed. Median age was 64 years (range 27-79) for UIP and 51 years (28-75) for NSIP (p< 0.001). Baseline characteristics: gender age smoking habits therapy NYHA PAP HRCT chest score Octreoscan uptake index (UI) DLCO and 6MWT.
RESULTS: Males 61.6% of UIP and 57.6% of NSIP, smokers 38.4% in UIP, and 51.5% in NSIP. UIP treated with prednisone-cyclophosphamide (81%) prednisone-azathioprine (19%). NSIP treated with prednisone-cyclophosphamide (27.3%) prednisone-azathioprine (12%) prednisone (61%). HRCT score was 4 in UIP and was 2 and 3 in 30% and 42% of NSIP. Octreoscan was 9.5 ± 0.2 UI in UIP and 12.6 ± 3.2 in NSIP (p< 0.001). NYHA class was 3 and 4 in 30% and 3% of UIP and 3 in 12% of NSIP. UIP showed higher values of PAP (57.6 ± 9.4 mmHg) than NSIP (46.5 ±11.9 mmHg p< 0.001). On the opposite NSIP had higher levels of 6MWT (197.3±71.9 m vs 152.5 ± 83.3 p=0.01) and of DLCO (61.6±14.9% vs 47.9±9.5 p< 0.001) Patients followed for a median period of 49.7 months (range 3.5-126.3). At the end of follow-up 62 subjects died (53 UIP and 9 NSIP). Median survival was 58.8 months (48.7 months in UIP and 99.4 in NSIP p< 0.001). Adjusting by age, negative prognostic factors were 1) NYHA: OR=3.9 for UIP and OR=6.9 for NSIP 2) PAP: OR=1.2 for UIP and OR=1.2 for NSIP. A higher survival was associated to 1) 6MWT: OR=0.98 for UIP and OR=0.96 for NSIP. 2) DLCO: OR=0.90 for UIP and OR=0.69 for NSIP. NSIP patients treated with prednisone survived less than patients treated with prednisone-cyclophosphamide (p=0.05).
CONCLUSION: Adjusting by age NYHA for UIP and NSIP and DLCO for NSIP were the emerging factors of survival.
CLINICAL IMPLICATIONS: We suggest applying these important factors in clinical practice of UIP and NSIP.
DISCLOSURE: Roberto Carbone, No Financial Disclosure Information; No Product/Research Disclosure Information