Longitudinal prediction of outcome in idiopathic pulmonary fibrosis using automated CT analysis
Year: 2019
Type: article
Abstract: ABSTRACT AIMS To evaluate computer-derived (CALIPER) CT variables against FVC change as potential drug trials endpoints in IPF. METHODS 71 Royal Brompton Hospital (discovery cohort) and 23 Mayo Clinic Rochester and 24 St Antonius Hospital Nieuwegein IPF patients (validation cohort) were analysed. Patients had two CTs performed 5-30 months apart, concurrent FVC measurements and were not exposed to antifibrotics (to avoid confounding of mortality relationships from antifibrotic use). Cox regression analyses (adjusted for patient age and gender) evaluated outcome for annualized FVC and CALIPER vessel-related structures (VRS) change and examined the added prognostic value of thresholded VRS changes beyond standard FVC change thresholds. RESULTS Change in VRS was a stronger outcome predictor than FVC decline when examined as continuous variables, in discovery and validation cohorts. When FVC decline (≥10%) and VRS thresholds were examined together, the majority of VRS change thresholds independently predicted outcome, with no decrease in model fit. When analysed as co-endpoints, a VRS threshold of ≥0·40 identified 30% more patients reaching an endpoint than a ≥10% FVC decline threshold alone. CONCLUSIONS Change in VRS is a strong predictor of outcome in IPF and can increase power in future drug trials when used as a co-endpoint alongside FVC change. Ethics committee approval Approval for this study of clinically indicated CT and pulmonary function data was obtained from Liverpool Research Ethics Committee (Reference: 14/NW/0028) and the Institutional Ethics Committee of the Royal Brompton Hospital, Mayo Clinic Rochester and St. Antonius Hospital, Nieuwegein. Informed patient consent was not required. Take home message Change in the vessel-related structures, a computer-derived CT variable, is a strong predictor of outcome in idiopathic pulmonary fibrosis and can increase power in future drug trials when used as a co-endpoint alongside forced vital capacity change.
Source: European Respiratory Journal
Authors: Joseph Jacob, Brian J. Bartholmai, Coline H.M. van Moorsel, Srinivasan Rajagopalan, Anand Devaraj, Hendrik W. van Es, Teng Moua, Frouke T. van Beek, Ryan Clay, Marcel Veltkamp, Maria Kokosi, Angelo de Lauretis, Eoin P. Judge, Teresa Burd, Tobias Peikert, Ronald Karwoski, Fabien Maldonado, Elisabetta Renzoni, Toby M. Maher, Andre Altmann, Athol U. Wells
Institutions: University College London, Mayo Clinic, University Medical Center Utrecht, St. Antonius Ziekenhuis, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, Aziende Socio Sanitaria Territoriale Rhodense, Aintree University Hospital, St George's Hospital, Vanderbilt University Medical Center, Imperial College London
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,877
OpenAlex ID: W2952373011