Idiopathic pulmonary fibrosis: Prognostic value of changes in physiology and six-minute-walk test

Kevin R. Flaherty, Adin Cristian Andrei, Susan Murray, Chris Fraley, Thomas V. Colby, William D. Travis, Vibha Lama, Ella A. Kazerooni, Barry H. Gross, Galen B. Toews, Fernando J. Martinez

Research output: Contribution to journalArticle

262 Scopus citations

Abstract

Rationale and Hypothesis: Idiopathic pulmonary fibrosis is a fatal disease with a variable rate of progression. We hypothesized that changes in distance walked and quantity of desaturation during a six-minute-walk test (6MWT) would add prognostic information to changes in FVC or diffusing capacity for carbon monoxide. Methods: One hundred ninety-seven patients with idiopathic pulmonary fibrosis were evaluated. Desaturation during the 6MWT was associated with increased mortality even if a threshold of 88% was not reached. Baseline walk distance predicted subsequent walk distance but was not a reliable predictor of subsequent mortality in multivariate survival models. The predictive ability of serial changes in physiology varied when patients were stratified by the presence/absence of desaturation ≤ 88% during a baseline 6MWT. For patients with a baseline saturation ≤ 88% during a 6MWT, the strongest observed predictor of mortality was serial change in diffusing capacity for carbon monoxide. For patients with saturation > 88% during their baseline walk test, serial decreases in FVC and increases in desaturation area significantly predicted subsequent mortality, whereas decreases in walk distance and in diffusing capacity for carbon monoxide displayed less consistent statistical evidence of increasing mortality in our patients. Conclusion: These data highlight the importance of stratifying patients by degree of desaturation during a 6MWT before attributing prognostic value to serial changes in other physiologic variables.

Original languageEnglish (US)
Pages (from-to)803-809
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume174
Issue number7
DOIs
StatePublished - Oct 1 2006

Keywords

  • Idiopathic pulmonary fibrosis
  • Prognosis
  • Pulmonary function
  • Six-minute-walk test
  • Survival

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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    Flaherty, K. R., Andrei, A. C., Murray, S., Fraley, C., Colby, T. V., Travis, W. D., Lama, V., Kazerooni, E. A., Gross, B. H., Toews, G. B., & Martinez, F. J. (2006). Idiopathic pulmonary fibrosis: Prognostic value of changes in physiology and six-minute-walk test. American journal of respiratory and critical care medicine, 174(7), 803-809. https://doi.org/10.1164/rccm.200604-488OC