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Background  Chronic hypersensitivity pneumonitis (CHP) has a variable disease course. Computer analysis of CT features was used to identify a subset of CHP patients with an outcome similar to patients with idiopathic pulmonary fibrosis (IPF).    Methods  Consecutive patients with a multi-disciplinary team diagnosis of CHP ( n  = 116) had pulmonary function tests (FEV1, FVC, DLco, Kco, and a composite physiologic index [CPI]) and CT variables predictive of mortality evaluated by analysing visual and computer-based (CALIPER) parenchymal features: total interstitial lung disease (ILD) extent, honeycombing, reticular pattern, ground glass opacities, pulmonary vessel volume (PVV), emphysema, and traction bronchiectasis. Mean survival was compared between both CHP and IPF patients ( n  = 185).    Results  In CHP, visual/CALIPER measures of reticular pattern, honeycombing, visual traction bronchiectasis, and CALIPER ILD extent were predictive of mortality ( p  < 0 · 05) on univariate analysis. PVV was strongly predictive of mortality on univariate ( p  < 0 · 0001) and multivariate analysis independent of age, gender and disease severity (represented by the CPI [ p  < 0 · 01]). CHP patients with a PVV threshold >6 · 5% of the lung had a mean survival (35 · 3 ± 6 · 1 months;  n  = 20/116 [17%]) and rate of disease progression that closely matched IPF patients (38 · 4 ± 2 · 2 months;  n  = 185).    Conclusions  Pulmonary vessel volume can identify CHP patients at risk of aggressive disease and a poor IPF-like prognosis.    Electronic supplementary material  The online version of this article (doi:10.1186/s12890-017-0418-2) contains supplementary material, which is available to authorized users.

Chronic hypersensitivity pneumonitis: identification of key prognostic determinants using automated CT analysis