Possibilities for predicting the course of fibrosing interstitial lung diseases based on a comprehensive study of the cardio-respiratory system

Abstract

Introduction. The problem of predicting the course of fibrosing interstitial lung diseases (FILD) is extremely relevant for the timely initiation of the treatment. Aim. To build a prognostic model based on data from a comprehensive study of the cardiorespiratory system in patients with FILD. Material and methods. The study included a group of 40 patients: 18 men and 22 women (M±S 60±9.7 years old), with verified FILD, who completed a full range of clinical and instrumental studies of the cardiorespiratory system at the time of inclusion in the study and after 12 months of observation. Then the initial group was divided into 2 groups: group A (20 patients), which did not reach the combined point, and group B (20 patients), which reached the combined point after 12 months. The combined point consisted of several outcomes: an increase in the degree of dyspnea on the m-MRC scale to 4 points, a deterioration in the results of the 6-minute walk test ≥50 m, a decrease in FVC or TLC ≥10 %, a decrease in the diffusing capacity of the lung for carbon monoxide (DLСO) ≥15 %, the lung transplantation, a death due to the lung disease. Results. Groups A and B did not have any differences in gender, age (А group (M±S) 57±11.8 y. o.; B group (M±S) 63±7.6 y. o., (p=0.06)), structure of the FILD nosology, the therapy and the frequency of the antifibrotic drug prescription. The hard endpoint at 12 months was achieved in 20 of 40 patients (50 %). Patients who reached the combined point were characterized by initially lower lung volumes (VC(M±S) 2.09±0.56 (p=0.016)); FVC (M±S) 1.99±0.55 (p=0.029)), FEV1 (M±S) 1.67±0.37 (p=0.036)), according to the results of a comprehensive study of the pulmonary function; a higher oxygen desaturation index (ODI (M±S) 5.76±4.48 (p=0.022)) and a more pronounced decrease in nocturnal saturation according to the computer pulse oximetry and the cardiorespiratory monitoring (SpO2 (M±S) 81.01±6.74 (p<0.029)). We developed a prognostic model that included such indicators as: post-bronchodilator MOC 75, TAPSE, VE/VCO2 (VO2 peak), desaturation index and minimum SPO2 % (AUC=0.949). Conclusion. The developed prognostic model for the course of FILD, based on the data from the comprehensive study of the cardiorespiratory system, demonstrated high sensitivity (93.8 %) and specificity (87.5 %).