Percent Predicted vs. Absolute Six-Minute Walk Distance as Predictors of Lung Transplant-Free Survival in Fibrosing Interstitial Lung Diseases.

IF 4.6 2区 医学 Q1 RESPIRATORY SYSTEM Lung Pub Date : 2024-12-01 Epub Date: 2024-09-20 DOI:10.1007/s00408-024-00748-5
Umberto Zanini, Jane Ding, Fabrizio Luppi, Karina Kaur, Niccolò Anzani, Giovanni Franco, Giovanni Ferrara, Meena Kalluri, Marco Mura
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Abstract

Introduction: Fibrosing interstitial lung diseases (ILDs) often progress despite treatment and become life-threatening, with lung transplant (LTx) remaining the only curative option. Six-minute walk distance (6MWD) is increasingly recognized as reliable predictor of clinical course, especially when longitudinally considered. The use of reference equations to express 6MWD as percent predicted (6MWD%) has not been previously studied in fibrosing ILDs. We sought to investigate whether the prognostic power of 6MWD% is superior to that of 6MWD expressed in meters (6MWD-m).

Methods: A retrospective, multicenter cohort analysis was conducted on both idiopathic pulmonary (IPF) and non-IPF fibrosing ILD patients. Patients were divided into a discovery (n = 211) and a validation (n = 260) cohort. Longitudinal changes of 6MWD% and lung function parameters were simultaneously considered. LTx-free survival at 3 years from baseline was the endpoint. Competing risks of death and LTx were considered.

Results: Baseline 6MWD% and its longitudinal changes were significant predictors of LTx-free survival and independent from lung function variables. In both cohorts, on multivariate cox proportional hazard regression analysis, receiver operating characteristics analysis and Kaplan-Meier estimates, 6MWD% was consistently, but only slightly superior to 6MWD-m as a predictor of LTx-free survival.

Conclusion: 6MWD% has only a slight, yet detectable advantage over 6MWD-m as a predictor of survival in fibrosing ILDs. Utilizing 6MWD% may aid in risk stratification, treatment monitoring, and LTx timing optimization. However, available reference equations do have predicting limitations. Refined predictive equations and standardizing reporting practices are therefore needed to further enhance the clinical utility of 6MWD% in fibrosing ILDs.

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预测的六分钟步行距离百分比与六分钟步行距离绝对值是纤维化间质性肺病患者无肺移植生存率的预测指标。
简介:纤维化间质性肺病(ILDs)往往在接受治疗后仍会恶化,危及生命,而肺移植(LTx)仍是唯一的治疗方法。六分钟步行距离(6MWD)越来越被认为是预测临床病程的可靠指标,尤其是在纵向考虑的情况下。使用参考方程将 6MWD 表示为预测百分比(6MWD%)的方法在纤维化 ILD 中尚未得到研究。我们试图研究 6MWD% 的预后能力是否优于以米(6MWD-m)表示的 6MWD:我们对特发性肺(IPF)和非 IPF 纤维化 ILD 患者进行了回顾性多中心队列分析。患者被分为发现组(211 人)和验证组(260 人)。同时考虑6MWD%和肺功能参数的纵向变化。终点为自基线起三年内无LTx生存率。考虑了死亡和LTx的竞争风险:结果:基线6MWD%及其纵向变化是无LTx生存率的重要预测因素,且与肺功能变量无关。在两个队列中,通过多变量cox比例危险回归分析、接受者操作特征分析和Kaplan-Meier估计,6MWD%在预测无LTx生存率方面始终略优于6MWD-m。利用 6MWD% 可能有助于风险分层、治疗监测和 LTx 时间优化。然而,现有的参考方程在预测方面存在局限性。因此,需要改进预测方程并规范报告方法,以进一步提高 6MWD% 在纤维性 ILD 中的临床实用性。
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来源期刊
Lung
Lung 医学-呼吸系统
CiteScore
9.10
自引率
10.00%
发文量
95
审稿时长
6-12 weeks
期刊介绍: Lung publishes original articles, reviews and editorials on all aspects of the healthy and diseased lungs, of the airways, and of breathing. Epidemiological, clinical, pathophysiological, biochemical, and pharmacological studies fall within the scope of the journal. Case reports, short communications and technical notes can be accepted if they are of particular interest.
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