Original Research: Diffuse Lung Disease |

Radiographic Fibrosis Score Predicts Survival in Hypersensitivity PneumonitisHypersensitivity Pneumonitis Survival Predictors

Joshua J. Mooney, MD; Brett M. Elicker, MD; Thomas H. Urbania, MD; Misha R. Agarwal, PhD; Christopher J. Ryerson, MD; Michelle Linh T. Nguyen, BA; Prescott G. Woodruff, MD, MPH; Kirk D. Jones, MD; Harold R. Collard, MD, FCCP; Talmadge E. King, Jr, MD; Laura L. Koth, MD
Author and Funding Information

From the Departments of Medicine (Drs Mooney, Agarwal, Woodruff, Collard, King, and Koth and Ms Nguyen), Radiology (Drs Elicker and Urbania), and Pathology (Dr Jones), University of California, San Francisco, CA; and the Department of Medicine (Dr Ryerson), University of British Columbia, Vancouver, BC, Canada.

Correspondence to: Laura L. Koth, MD, Department of Medicine, University of California San Francisco, Box 0111, 505 Parnassus Ave, San Francisco, CA 94143; e-mail: Laura.Koth@ucsf.edu

Drs Elicker, Urbania, and Agarwal contributed equally to this article.

Part of this article was presented in abstract form at the American Thoracic Society International Conference, May 18-23, 2012, San Francisco, CA (abstract 4365).

Funding/Support: This study was supported by departmental sources from the University of California San Francisco.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Chest. 2013;144(2):586-592. doi:10.1378/chest.12-2623
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Background:  It is unknown if the radiographic fibrosis score predicts mortality in persistent hypersensitivity pneumonitis (HP) and if survival is similar to that observed in idiopathic pulmonary fibrosis (IPF) when adjusting for the extent of radiographic fibrosis.

Methods:  We reviewed records from 177 patients with HP and 224 patients with IPF whose diagnoses were established by multidisciplinary consensus. Two thoracic radiologists scored high-resolution CT (HRCT) scan lung images. Independent predictors of transplant-free survival were determined using a Cox proportional hazards analysis. Kaplan-Meier survival curves were constructed, stratified by disease as well as fibrosis score.

Results:  HRCT scan fibrosis score and radiographic reticulation independently predicted time to death or lung transplantation. Clinical predictors included a history of cigarette smoking, auscultatory crackles on lung examination, baseline FVC, and FEV1/FVC ratio. The majority of HP deaths occurred in patients with both radiographic reticulation and auscultatory crackles on examination, compared with patients with only one of these manifestations (P < .0001). Patients with IPF had worse survival than those with HP at any given degree of radiographic fibrosis (hazard ratio 2.31; P < .01).

Conclusions:  Survival in patients with HP was superior to that of those with IPF with similar degrees of radiographic fibrosis. The combination of auscultatory crackles and radiographic reticulation identified patients with HP who had a particularly poor outcome.

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