Abstract
BackgroundThe mortality risk of chronic interstitial lung disease (ILD) is currently assessed using the ILD-GAP score. The present study evaluates whether the addition of cardiopulmonary ultrasound parameters to the ILD-GAP score can further improve the predictive value of ILD-GAP.MethodsMedical records from 91 patients with ILD hospitalized from June 2015 to March 2016 were retrospectively examined. The Lung ultrasound (LUS) score, right ventricular (RV) function, and mechanics were obtained from the cardiopulmonary ultrasound. The ILD-GAP score was calculated from demographic characteristics and pulmonary function parameters. Patients were followed up with until May 2020. The primary endpoint was all-cause death.ResultsAfter exclusions, 74 patients with ILD were included in the analysis. During the follow-up period, 36 patients with ILD survived (ILDs), and 38 patients died (ILDd). Compared to ILDs, the ILDd cases exhibited a higher number of B-lines, LUS score, and RV end-diastolic base dimension (RVD), but lower RV function. In multivariate analysis, the ILD-GAP score (hazard ratio, 2.88; 95% CI 1.38–5.99, P = 0.005), LUS score (hazard ratio 1.13; 95% CI 1.04–1.24, P = 0.006), and RVD (hazard ratio 1.09, 95% CI 1.03–1.16, P = 0.004) were significantly related to the risk of death. Adding the LUS score and RVD to the ILD-GAP score significantly improved the predictive value compared to the ILD-GAP score alone (C statistics 0.90 vs 0.76, P = 0.018).ConclusionWe investigated the utility of a new prognostic model for ILD that includes both cardiopulmonary ultrasound parameters (LUS score and RVD) and the ILD-GAP score. This model better reflects the severity of pulmonary fibrosis and cardiac involvement, and has incremental predictive value over the ILD-GAP score alone.
Highlights
The mortality risk of chronic interstitial lung disease (ILD) is currently assessed using the ILD-GAP score
The main finding of the present study is that the combination of cardiopulmonary ultrasound parameters, notably the lung ultrasound (LUS) score and right ventricular (RV) end-diastolic base dimension (RVD), with the ILD-GAP score improves the prediction of prognosis in patients with ILD compared to the ILD-GAP score alone
We showed that RVD and right ventricular global longitudinal strain (RVGLS) were more related to the outcome of patients with ILD than the systolic pulmonary artery pressure (SPAP) parameter
Summary
The mortality risk of chronic interstitial lung disease (ILD) is currently assessed using the ILD-GAP score. A scoring system for the evaluation of pulmonary fibrosis in patients with ILD based on LUS findings was proposed by Buda et al [10], the results of which correlated well with the HRCT Warrick score. For patients with ILD, cardiopulmonary ultrasound, which is the combined use of LUS and echocardiography, can assess the severity of pulmonary fibrosis and cardiac involvement, such as pulmonary hypertension or right heart failure, which is highly correlated with a poorer prognosis. This allows the most appropriate, individualized interventions to be delivered to the patients [13, 14]
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