Abstract
BackgroundThe precise classification of idiopathic interstitial pneumonia (IIP) is essential for selecting treatment as well as estimating clinical outcomes; however, this is sometimes difficult in clinical practice. Therefore, cluster analysis was used to identify the clinical phenotypes of IIPs, and its usefulness for predicting clinical outcomes was evaluated.MethodsCluster analysis was performed using clinical features including patients’ demographics; histories; pulmonary function test data; and laboratory, physical and radiological findings.ResultsIn 337 patients with IIPs, four clusters were identified: Cluster I, in which > 80% of the patients had autoimmune features; Cluster II, which had the lowest rate of smoking, the lowest percent predicted forced vital capacity (%FVC) and the lowest body mass index (BMI); Cluster III, which had the highest rate of smoking, the highest rate of dust exposure, the second lowest %FVC and normal BMI; and Cluster IV, which exhibited maintenance of %FVC and normal BMI. Cluster IV had significantly longer overall survival than Clusters II and III. Clusters I and III had significantly longer overall survival than Cluster II. Clusters II and III had a significantly higher cumulative incidence of acute exacerbation than Cluster IV.ConclusionCluster analysis using clinical features identified four clinical phenotypes of IIPs, which may be useful for predicting the risk of acute exacerbation and overall survival.
Highlights
The precise classification of idiopathic interstitial pneumonia (IIP) is essential for selecting treatment as well as estimating clinical outcomes; this is sometimes difficult in clinical practice
Cluster analysis using clinical features identified four clinical phenotypes of IIPs, which may be useful for predicting the risk of acute exacerbation and overall survival
Aoshima et al BMC Pulm Med (2021) 21:63 a usual interstitial pneumonia (UIP) pattern characterized by honeycombing on high-resolution computed tomography (HRCT) that is eventually diagnosed as idiopathic pulmonary fibrosis (IPF)
Summary
The precise classification of idiopathic interstitial pneumonia (IIP) is essential for selecting treatment as well as estimating clinical outcomes; this is sometimes difficult in clinical practice. Idiopathic interstitial pneumonias (IIPs) consist of heterogeneous interstitial lung diseases of unknown aetiology. Aoshima et al BMC Pulm Med (2021) 21:63 a usual interstitial pneumonia (UIP) pattern characterized by honeycombing on high-resolution computed tomography (HRCT) that is eventually diagnosed as IPF. In these patients, it is difficult to accurately diagnose the disease in the first examination. Surgical lung biopsy, an essential procedure for the diagnosis of IIPs, cannot be performed in all patients [8]. Transbronchial cryobiopsy has attracted attention as a less invasive procedure than surgical lung biopsy; its utility for the diagnosis of IIPs remains a matter of debate [10, 11]
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