Clinical lung and heart/lung transplantation
The 15-Step Oximetry Test: a Reliable Tool to Identify Candidates for Lung Transplantation Among Patients With Idiopathic Pulmonary Fibrosis

https://doi.org/10.1016/j.healun.2008.12.019Get rights and content

Background

Idiopathic pulmonary fibrosis (IPF) is a relentlessly progressive disease with a median survival of approximately 3 years. Measurements of lung volumes and diffusion capacity at rest are generally used to monitor the clinical course of IPF. Due to its high mortality, identification of patients at high risk is crucial for treatment strategies such as lung transplantation. This study was design to determine whether the simple 15-step climbing exercise oximetry test accurately characterizes disease severity and survival in patients with IPF.

Methods

The study population consisted of 51 patients with progressive IPF. Findings on the 15-step climbing test, pulmonary function tests, cardiopulmonary exercise test and 6-minute walk distance test were assessed at baseline. Participants were prospectively followed for ≥2 years to determine the relationship between the test parameters and survival.

Results

On univariate analysis, there were strong correlations between the 15-stair climbing test parameters and survival. On stepwise linear regression analysis, independent significant predictors of mortality were lowest saturation levels on the 15-step test and the 6-minute walk distance test.

Conclusions

The lowest saturation and desaturation areas on the 15-step oximetry test are significantly associated with long-term outcome in patients with IPF. We suggest that the 15-step test be used as a simple and reliable tool to predict severity and prognosis in IPF and to identify candidates for lung transplantation.

Section snippets

Patients and Setting

A prospective, open study design was used. The study group comprised 51 patients with IPF attending the Pulmonary Institute of Rabin Medical Center, a tertiary hospital in central Israel, during the 6-month period from January to June 2004. Diagnoses were made according to the criteria of the American Thoracic Society (ATS).1 Individuals with collagen vascular disease, occupational lung disease, sarcoid, hypersensitivity pneumonitis and/or other idiopathic interstitial pneumonias were excluded.

Demographic Data

All 51 patients completed the PFTs and the three exercise tests (CPET, 6MWD test and 15-step oximetry test).

Table 1 summarizes the demographic and clinical data. Twenty-nine patients were male. Mean age was 58 ± 11 years (range 17 to 80 years). Twenty-four patients were non-smokers, 25 had smoked in the past, and 2 continued to smoke during the study period. Most of the patients (94%) were New York Heart Association (NYHA) Functional Class II to IV. Twenty-five (50%) patients were being treated

Discussion

The main finding of the present study is that the lowest saturation on the simple step-climbing test is an accurate predictive parameter of mortality in IPF.

To provide patients with IPF with proper prognostic information, researchers have suggested various protocols with potential predictive value. It has been reported that increasing pulmonary artery pressure is a risk factor for death after single-lung transplantation in IPF.20 PFTs are traditionally used to evaluate patients with

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