Development of a Tool to Assess the Severity of PH-ILD: A Guide to Assist Therapeutic Choices

Abstract

Abstract Pulmonary hypertension (PH) is a frequent complication in patients with interstitial lung disease (ILD); its occurrence results in significant morbidity and mortality. Currently approved treatment options for PH-ILD include inhaled prostacyclin therapy, although this approach may be insufficient in patients who have developed concomitant right ventricular failure. Moreover, there is no available treatment algorithm regarding the optimal therapy and timing of lung transplant referral for PH-ILD patients based on disease severity. In this study, we created such a tool to guide PH-specific therapy in PH-ILD patients, especially as further treatment strategies are developed. We developed a 4-point PH‐ILD Severity score that integrated both subjective and objective information from retrospective analysis of 57 PH-ILD patients. A score of 3 or greater in the PH-ILD Severity score yielded an AUC of 0.831 (p < 0.001) for the composite endpoint of clinical worsening (hospitalization due to a cardiopulmonary indication; decrease in 6-minute walk distance by > 15% at 2 consecutive visits; all-cause mortality; lung transplantation). Further confirmation and evolution of this PH-ILD Severity score will assist in development of optimal treatment plans in ILD patients diagnosed with concomitant PH.