Computer-based computed tomography (CT) analysis can provide objective quantitation of disease in idiopathic pulmonary fibrosis (IPF). A computer algorithm, CALIPER, was compared with conventional CT and pulmonary function measures of disease severity for mortality prediction.CT and pulmonary function variables (forced expiratory volume in 1 s, forced vital capacity, diffusion capacity of the lung for carbon monoxide, transfer coefficient of the lung for carbon monoxide and composite physiologic index (CPI)) of 283 consecutive patients with a multidisciplinary diagnosis of IPF were evaluated against mortality. Visual and CALIPER CT features included total extent of interstitial lung disease, honeycombing, reticular pattern, ground glass opacities and emphysema. In addition, CALIPER scored pulmonary vessel volume (PVV) while traction bronchiectasis and consolidation were only scored visually. A combination of mortality predictors was compared with the Gender, Age, Physiology model.On univariate analyses, all visual and CALIPER-derived interstitial features and functional indices were predictive of mortality to a 0.01 level of significance. On multivariate analysis, visual CT parameters were discarded. Independent predictors of mortality were CPI (hazard ratio (95% CI) 1.05 (1.02-1.07), p<0.001) and two CALIPER parameters: PVV (1.23 (1.08-1.40), p=0.001) and honeycombing (1.18 (1.06-1.32), p=0.002). A three-group staging system derived from this model was powerfully predictive of mortality (2.23 (1.85-2.69), p<0.0001).CALIPER-derived parameters, in particular PVV, are more accurate prognostically than traditional visual CT scores. Quantitative tools such as CALIPER have the potential to improve staging systems in IPF.

Background: Limited data exist regarding the population-based epidemiology of idiopathic pulmonary fi brosis (IPF). The objective of the study was to describe the trends in the incidence, prevalence, and clinical course of IPF in the community. Methods:We conducted a population-based study of adult patients with IPF in Olmsted County, Minnesota, from 1997 to 2005. Two methods were used to identify IPF cases, as defi ned by the 2002 American Thoracic Society/European Respiratory Society consensus statement: (1) usual interstitial pneumonia (UIP) on a surgical lung biopsy specimen or a defi nite UIP pattern on a high-resolution CT image (narrow criteria) and (2) UIP on a surgical lung biopsy specimen or a defi nite or possible UIP pattern on CT image (broad criteria). Results: Of 596 patients screened for the possibility of pulmonary disease or pulmonary fi brosis over 9 years of follow-up, 47 cases had IPF. Of these, 24 met the narrow criteria. The age-and sex-adjusted incidence was 8.8/100,000 and 17.4/100,000 person-years, for narrow and broad criteria, respectively. The age-adjusted incidence was higher in men than in women, and among patients aged 70-79 years. During the study period, the incidence of IPF decreased ( P , .001). On December 31, 2005, the age-and sex-adjusted prevalence was 27.9/100,000 and 63/100,000 persons by narrow and broad criteria, respectively. Thirty-seven patients experienced a total of 53 respiratory exacerbations (26 IPF related, 27 non-IPF related), and 34 (72%) patients died. The primary cause of death was IPF related in 16 (47%) patients. Median survival for narrow-criteria and broad-criteria incidence cases was 3.5 and 4.4 years, respectively. Conclusions: The incidence of IPF in Olmsted County decreased over the study period. Nonprimary IPF respiratory exacerbations are as frequent as primary IPF respiratory exacerbations and an important cause of death.CHEST 2010; 137( 1 ):129-137Abbreviations: ATS/ERS 5 American Thoracic Society and European Respiratory Society; HRCT 5 high-resolution computed tomography; IPF 5 idiopathic pulmonary fi brosis; REP 5 Rochester Epidemiology Project; UIP 5 usual interstitial pneumonia

Severe COVID-19 pneumonia survivors often exhibit long-term pulmonary sequalae, but the underlying mechanisms or associated local and systemic immune correlates are not known. Here, we have performed high-dimensional characterization of the pathophysiological and immune traits of aged COVID-19 convalescents, and correlated the local and systemic immune profiles with pulmonary function and lung imaging. We found that chronic lung impairment was accompanied by persistent respiratory immune alterations. We showed that functional SARS-CoV-2-specific memory T and B cells were enriched at the site of infection compared to those of blood. Detailed evaluation of the lung immune compartment revealed dysregulated respiratory CD8 + T cell responses were associated with the impaired lung function following acute COVID-19. Single cell transcriptomic analysis identified the potential pathogenic subsets of respiratory CD8 + T cells contributing to persistent tissue conditions following COVID-19. Our results have revealed pathophysiological and immune traits that may support the development of lung sequelae following SARS-CoV-2 pneumonia in older individuals, with implications for the treatment of chronic COVID-19 symptoms.

No abstract

clinicaltrials.gov Identifier: NCT02550873.