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Prognostic Implication of Diagnostic Confidence Level in Patients with Fibrotic Hypersensitivity Pneumonitis

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Abstract
Background: Hypersensitivity pneumonitis (HP) has various clinical courses and outcomes, but the prognostic factors are not well-defined. Vasakova et al. [Am J Respir Crit Care Med. 2017 Sep;196(6):680?9] have proposed a diagnostic algorithm that categorized suspected patients according to the level of confidence in the diagnosis. This study aimed to investigate whether the confidence level of clinical diagnosis has prognostic implication in patients with fibrotic HP. Methods: This study included 101 biopsy-proven fibrotic HP patients diagnosed between 2002 and 2017. The patients were retrospectively classified into confident, probable, possible, and unlikely chronic HP, according to the confidence level in the diagnostic criteria/algorithm. The survival and forced vital capacity (FVC) changes were compared between the groups. Risk factors for mortality were analysed using a Cox proportional hazard model. Results: The median follow-up duration was 67.6 months. The mean age was 60.4 years, and percentages of women were 60.4%. When classified based on the diagnostic criteria/algorithm, possible HP was the most common (51.5%), followed by probable (26.7%), confident (9.9%), and unlikely HP (6.9%). Distinctive survival curves were found according to the diagnostic confidence level, showing the worst outcome in unlikely chronic HP (median survival, 30.2 months). In a multivariable Cox analysis, unlikely HP was a significant predictor of poor survival (hazard ratio, 4.652; 95% confidence interval, 1.231?17.586; p = 0.023), after adjustment for age, body mass index, FVC, and diffusing capacity. Conclusions: The diagnostic confidence level may predict clinical outcomes in patients with HP. Unlikely HP was shown to have a significantly poorer survival than other diagnostic confidence levels.
Author(s)
강지은송준선송진우채은진Jooae ChoeYeon Joo Kim
Issued Date
2021
Type
Article
Keyword
Clinical Investigations
DOI
10.1159/000517921
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7078
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_crossref_primary_10_1159_000517921&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,Prognostic%20Implication%20of%20Diagnostic%20Confidence%20Level%20in%20Patients%20with%20Fibrotic%20Hypersensitivity%20Pneumonitis&offset=0&pcAvailability=true
Publisher
RESPIRATION
Location
스위스
Language
영어
ISSN
0025-7931
Citation Volume
100
Citation Number
10
Citation Start Page
940
Citation End Page
948
Appears in Collections:
Medicine > Medicine
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