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A simple dyspnoea scale as part of the assessment to predict outcome across chronic interstitial lung disease
Author(s) -
Khadawardi Hadeel,
Mura Marco
Publication year - 2017
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.12945
Subject(s) - medicine , interstitial lung disease , idiopathic pulmonary fibrosis , vital capacity , population , lung transplantation , area under the curve , diffusing capacity , lung , lung function , environmental health
Background and objective The Medical Research Council dyspnoea score ( MRCDS ) is a simple, objective scale to assess dyspnoea, the main complaint in patients with chronic interstitial lung disease ( ILD ). We sought to investigate whether MRCDS is a predictor of outcome in patients with chronic ILD . Methods One hundred and fifteen patients (50 idiopathic pulmonary fibrosis ( IPF ) and 65 non‐ IPF ILD ) were retrospectively studied. Baseline (time of diagnosis) MRCDS and 3–6‐month changes were considered. Endpoints were (i) 18‐month clinical progression, defined as either: ≥10% absolute reduction in forced vital capacity ( FVC ) percent predicted; ≥50‐m decline in 6‐min walk distance; hospitalization for respiratory causes; lung transplantation ( LTx ) assessment or death and (ii) 18‐month survival. Results At the end of the observation period, 54 subjects (47%) experienced clinical progression (including 22 deaths and 3 LTx ). In patients with IPF , a longitudinal increase in MRCDS predicted clinical progression significantly (area under the curve ( AUC ) = 0.76, sensitivity = 62%, specificity = 91%); baseline MRCDS was a strong predictor of mortality ( AUC = 0.80, sensitivity = 87%, specificity = 57%). In patients with non‐ IPF ILD , longitudinal increases in MRCDS , but not baseline values, were predictive of both clinical progression ( AUC = 0.81, sensitivity = 85%, specificity = 77%) and mortality ( AUC = 0.76, sensitivity = 91%, specificity = 61%). Considering the whole population, MRCDS increase and FVC decline were independent predictors of mortality. Conclusion Longitudinal increases of MRCDS predict poor outcome in chronic ILD , with good accuracy. Baseline MRCDS remains a strong predictor of mortality in IPF . MRCDS should be included in the global assessment of the clinical course of chronic ILD .