One-Year Change in Quantitative Computed Tomography Is Associated with Meaningful Outcomes in Fibrotic Lung Disease

Abstract Rationale Whether change in fibrosis on high-resolution computed tomography is associated with near- and longer-term outcomes in patients with fibrotic interstitial lung disease (fILD) remains unclear. Objectives We evaluated the association between 1-year change in quantitative fibrosis scores (data-driven textural analysis [DTA]) and subsequent FVC and survival in patients with fILD. Methods The primary cohort included patients with fILD evaluated from 2017 to 2020 with baseline and 1-year follow-up high-resolution computed tomography and FVC. Associations between DTA change and subsequent FVC were assessed using linear mixed models. Transplant-free survival was assessed using Cox proportional hazards models. The Pulmonary Fibrosis Foundation Patient Registry served as the validation cohort. Measurements and Main Results The primary cohort included 407 patients (median [interquartile range] age, 70.5 [64.8, 75.9] yr; 214 male). One-year increase in DTA was associated with subsequent FVC decline and transplant-free survival. The largest effect on FVC was observed in patients with low baseline DTA scores, in whom a 5% increase in DTA over 1 year was associated with a change in FVC of −91 ml/yr (95% confidence interval [CI], −117, −65 vs. stable DTA, −49 ml/yr; 95% CI, −69, −29; P = 0.0002). The hazard ratio for transplant-free survival for a 5% increase in DTA over 1 year was 1.45 (95% CI, 1.25, 1.68). The findings were confirmed in the validation cohort. Conclusions One-year change in DTA score is associated with future disease trajectory and transplant-free survival in patients with fILD. DTA could be a useful trial endpoint, cohort enrichment tool, and metric to incorporate into clinical care.