Certain findings in a patient with idiopathic pulmonary fibrosis may indicate a longer survival vs disease progression.
|
Parameter
|
Longer Survival (Favorable Factors)
|
Progressive Disease (Unfavorable Factors)
|
|
age
|
< 50 years
|
|
|
gender
|
female
|
|
|
symptomatic period
|
<= 1 year
|
|
|
pulmonary function
|
preserved with mild dyspnea
|
severe dyspnea
|
|
history of current cigarette smoking at time of diagnosis
|
present
|
|
|
high resolution CT scan
|
ground glass and reticular opacities present
|
extensive fibrosis
|
|
BAL fluid findings
|
increased lymphocytes (> 20%)
|
neutrophils > 5% or eosinophils > 5%
|
|
response to corticosteroid therapy at 3-6 months
|
beneficial response or stable disease
|
progressive disease
|
|
need for immuno-suppressive therapy
|
none
|
yes
|
where:
• I wonder if the short symptomatic period indicating longer survival is a form of bias.
• The need for immunosuppression and the severity of dyspnea are proxy measures for disease severity.
