Prognostic value of the 6-min walk test derived attributes in patients with idiopathic pulmonary fibrosis

Ada E M Bloem, Hanneke M Dolk, Anne E Wind, Joanne J van der Vis, Maarten J Kampen, Jan W H Custers, Martijn A Spruit, Marcel Veltkamp

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is a fatal progressive fibrosing lung disease. A decreased 6-min walk distance (6MWD) and exercise-induced oxygen desaturation measured during the 6-min walk test (6MWT), are known predictors of mortality in patients with IPF. However, the use of antifibrotic drugs showed a survival benefit in IPF. Therefore, this study aimed to evaluate to what extend 6MWT-derived attributes are associated with two-year survival when antifibrotic drugs were introduced as part of standard IPF-care. METHODS: This real-world data-study included patients with IPF with a 6MWT between 2015 and 2020, and used composite outcome: mortality or lung transplantation within 2 years of follow-up. Data were collected systematically, including demographics, pulmonary function tests, comorbidities, medications and 6MWT-derived attributes. The prediction attributes of 6MWT were studied with a Cox Proportional-Hazards model and Kaplan-Meier survival curves. The best discriminating attribute to predict mortality was added to the prediction model Gender-Age-Physiology (GAP). RESULTS: In 216 patients, 2-year transplant-free survival cut-off points were identified for the 6MWD (=413 m), 6MWD %predicted (=83 %), SpO -nadir (=86 %) and distance-saturation-product (=374 m%), with the best discriminative value for SpO -nadir (area under the curve: 0.761). 2-Year survival percentage of patients with SpO -nadir below or above threshold (86 %) was 37.1 % and 80.0 %, respectively. Exercise-induced oxygen desaturation added to the GAP model showed an improvement in its predictive power. CONCLUSION: Patients with IPF who have an exercise-induced oxygen desaturation have worse prognosis. Addition of SpO -nadir to the GAP model seems promising for use in clinical care of IPF patients.
Original languageEnglish
Article number107862
JournalRespiratory Medicine
Volume236
Early online date20 Nov 2024
DOIs
Publication statusPublished - 2025

Keywords

  • 6-min walk test (6MWT)
  • Functional exercise capacity
  • GAP (Gender-Age-Physiology) model
  • Idiopathic pulmonary fibrosis (IPF)
  • Physiotherapy
  • Prognostic

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